The current H5N1 avian flu outbreak in poultry and dairy cows in the US has raised the alarm on bird flu and its transmission risk across species. At present, the virus has infected 100 million birds across 48 states and 196 dairy herds across 14 states. Luckily, the H5N1 avian flu, which is very lethal in birds, does not transmit easily into humans nor does it generally cause severe and systemic symptoms when humans are infected. Still, workers most exposed to these infected animals are testing positive with 14 human cases reported so far since 2022. 

In this Communicable episode, hosts Angela and Nav are joined by avian flu expert Ron Fouchier (Erasmus MC Rotterdam, Netherlands) to discuss the most recent developments of the outbreak in the US and the potential risks H5N1 virus poses to humans. Understanding of the virus from its first reported outbreak in Hong Kong in 1997 to its global prevalence today is reviewed. While H5N1 bird flu does not pose as a global human health concern at present, unchecked practices in the dairy, meat, and agricultural industry sectors, in which workers are exposed to the virus, threaten to change the status quo. Learn why the threat is even more paramount in fall when human influenza or seasonal flu is widespread, and to what extent the government should also be involved in prevention and containment measures before it becomes, in Ron’s words, another “missed opportunity.”          

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Simon Galmiche of the Institut Pasteur, Université Paris Cité, Paris, France.

Literature

US Centers for Disease Control and Prevention (CDC). H5 Bird Flu: Current Situation. 2024. https://www.cdc.gov/bird-flu/situation-summary 

Only known to us since 2008, Candida auris is an emerging fungal pathogen spreading quickly around the world; alarmingly, it is most commonly found in healthcare settings. C. auris sets itself apart from other Candida species with its unique tolerance to high saline and temperature environments and propensity to develop antifungal resistances that promote its survival in hospitals and healthcare facilities. 

Hosts Emily McDonald and Navaneeth Narayanan are joined by fungal experts Dr. Jeffrey Rybak (St. Jude, Memphis TN) and Dr. Graham Snyder (UPMC, Pittsburgh PA) on their quest to better understand C. auris infections, the clinical challenges and knowledge gaps in C. auris research and discuss measures for prevention and containment on the levels of both the patient and the institution. 

The recent emergence of C. auris as a multidrug-resistant nosocomial pathogen and its global prevalence has raised more questions than answers. Why now? Why healthcare facilities? Does climate change play a role? Are humans to blame? Tune in to find out what the experts have to say on these questions, and stay to learn about the current therapies available, what is in the antifungal pipeline and how to approach treatment from a stewardship standpoint.

This episode was produced by Angela Huttner, edited by Kathryn Hostettler and peer-reviewed by Dr. Claudio Neidhöfer of University Hospital Bonn, Germany.

Literature

Satoh K, Makimura K, Hasumi Y, et al. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol. 2009 Jan;53(1):41-4. doi: 10.1111/j.1348-0421.2008.00083.x

Lee WG, Shin JH, Uh Y, et al. First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol. 2011 Sep;49(9):3139-42. doi: 10.1128/JCM.00319-11

Pfaller MA, Diekema DJ, Turnidge JD, et al. Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997–2016. OFID. 2019 March;6(S1): S79–S94. doi: 10.1093/ofid/ofy358

Lockhart SR, Etienne KA, Vallabhaneni S, et al. Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses. Clin Infect Dis. 2017 Jan 15;64(2):134-140. doi: 10.1093/cid/ciw691.

Clancy CJ, Nguyen MH. Emergence of Candida auris: An International Call to Arms. Clin Infect Dis. 2017 Jan 15;64(2):141-143. doi: 10.1093/cid/ciw696

Rybak JM, Cuomo CA, Rogers PD. The molecular and genetic basis of antifungal resistance in the emerging fungal pathogen Candida auris. Curr Opin Microbiol. 2022 Dec;70:102208. doi: 10.1016/j.mib.2022.102208 

Once considered endemic only to tropical and subtropical climates such as Southeast Asia and northern Australia, melioidosis is expanding to non-endemic areas such as the southern US. Climate change is impacting infectious diseases, melioidosis being no exception. Now is the time to inform and prepare: as this Communicable episode’s title indicates, melioidosis is going global.

Join hosts Angela Huttner and Josh Davis on their in-depth exploration of melioidosis with invited experts Dr. Ella Meumann and Prof. Bart Currie from Royal Darwin Hospital, Darwin, Australia. Topics range from melioidosis discovery, clinical presentation, diagnostic approaches and host risk factors to the disease’s expanding endemicity.

Melioidosis is an infectious disease caused by the sapronotic agent Burkholderia pseudomallei and contracted by both people and animals through direct contact with contaminated soil, air or waters. Current burden estimates of 169’000 cases and 89’000 deaths per year are thought to be grossly underreported due to limited access to laboratory diagnostics and lack of clinical awareness. Experts call for melioidosis to be recognized as a neglected tropical disease in order to give this disease the urgent attention and resources it deserves.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Goulia Ohan of Yerevan State Medical University, Armenia.

Literature 

Meumann EM and Currie BJ. Approach to melioidosis. CMI Comms 2024;1(1). doi: 10.1016/j.cmicom.2024.100008 

Savelkoel J, Dance D. Alfred Whitmore and the Discovery of Melioidosis. Emerg Infect Dis. 2024;30(4):752-756. doi:10.3201/eid3004.230693 

Limmathurotsakul D, Wongsuvan G, Aanensen D et al. Melioidosis Caused by Burkholderia pseudomallei in Drinking Water, Thailand, 2012. Emerg Infect Dis. 2014;20(2):265-268. doi: 10.3201/eid2002.121891 

Petras JK, Elrod MG, Ty MC, et al. Locally acquired melioidosis linked to environment—Mississippi, 2020-2023. N Engl J Med. 2023;389:2355-2362. doi: 10.1056/NEJMoa2306448

Howes M and Currie BJ. Melioidosis and Activation from Latency: The “Time Bomb” Has Not Occurred. ASTMH. 28 May 2024;111(1): 156-160. doi 10.4269/ajtmh.24-0007

Responsible for 1.3 million deaths and 2.2 million new infections per year, viral hepatitis is the second leading cause of morbidity and mortality amongst all infectious diseases, just behind tuberculosis. 

Hosts Angela Huttner and Oana Sandulescu welcome special guest and leading hepatitis expert, Professor Mojca Matičič, MD, PhD (Ljubljana, Slovenia), to refresh your knowledge on the pathogenesis of hepatitis B & C infections, review the latest direct-acting antiviral (DAA) therapies, map out some countries’ successful elimination initiatives, and understand challenges remaining for others.

In recognition of World Hepatitis Day this Sunday, 28 July, a day dedicated to raising awareness about viral hepatitis, we are releasing our latest episode a few days early. The World Hepatitis Day theme this year is: it’s time for action! The Communicable team urges our listeners to inform themselves and others, and to test, treat, and vaccinate against viral hepatitis. 

This episode was peer reviewed by Dr. Liem Luong of CIC Cochin Pasteur, Hôpital Cochin-Port Royal, Assistance Publique-Hôpitaux de Paris, Paris, France.

Literature

World Hepatitis Day 2024: It’s time for action. Geneva: World Health Organization; 2024. https://www.who.int/campaigns/world-hepatitis-day/2024

“WHO sounds alarm on viral hepatitis infections claiming 3500 lives each day.”  Geneva: World Health Organization; 9 April 2024. https://www.who.int/news/item/09-04-2024-who-sounds-alarm-on-viral-hepatitis-infections-claiming-3500-lives-each-day 
 

Global hepatitis report 2024: action for access in low- and middle-income countries. Geneva: World Health Organization; 2024. doi: 10.2471/B09024. 

The European Association of the Study of the Liver (EASL). EASL Congress Milan, Italy 5-8 June 2024. https://www.easlcongress.eu/ 

ESCMID. Cutting Edge Insights into Viral Hepatitis: Recent Scientific Breakthroughs and Clinical Updates. Lund, Sweden 13-14 June 2024. https://www.escmid.org/event-detail/cutting-edge-insights-into-viral-hepatitis-recent-scientific-breakthroughs-and-clinical-updates/ 

European Centre for Disease Prevention and Control (ECDC). ECDC Evidence brief: Prevention of hepatitis B and C in the EU/EEA. Stockholm: ECDC; 2024.

European Centre for Disease Prevention and Control. Hepatitis C. In: ECDC. Annual epidemiological report for 2022. Stockholm: ECDC; 2024.

Burnet Institute and Kirby Institute. Australia’s progress towards hepatitis C elimination: annual report 2022. Melbourne: Burnet Institute; 2022.

Maticic M, Pirnat Z, Leicht A, et al. The civil society monitoring of hepatitis C response related to the WHO 2030 elimination goals in 35 European countries. Harm Reduct J. 2020 Nov 19;17(1):89. doi: 10.1186/s12954-020-00439-3 

The ‘I’ (intermediate susceptibility) in a EUCAST-guided antibiogram never meant impending resistance to your antibiotic. It was never meant to make you find the one ‘S’ (invariably a carbapenem) and use it instead—even if many clinicians did. 

In this episode of Communicable, hosts Marc Bonten and Angela Huttner welcome Profs. Christian Giske (outgoing chair) and Sören Gatermann (newly elected chair) of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) to discuss its recent updates, including the new ‘susceptible dose dependent’ (SDD) label, and to shed light on common misconceptions around the way it sets breakpoints. Breakpoints for Pseudomonas aeruginosa are discussed, as are intravenous fosfomycin’s ‘disappearance’ from the breakpoints table and EUCAST’s new guidance on it. Episode peer-reviewed by Dr. Suzanne van Asten of Radboud University Medical Center.

Literature:
The European Committee on Antimicrobial Susceptibility Testing (EUCAST): https://www.eucast.org/

EUCAST guidance on use of fosfomycin i.v. breakpoints:
https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Guidance_documents/Use_of_fosfomycin_iv_breakpoints_General_advice_20240528.pdf

In vitro synergy between fosfomycin and ceftazidime/avibactam:
Kroemer, Martens, Decousser et al. Evaluation of in vitro pharmacodynamic drug interactions of ceftazidime/avibactam and fosfomycin in Escherichia coli. J Antimicrob Chemother. 2023 Oct 3;78(10):2524-2534. doi: 10.1093/jac/dkad264

Hosts Angela Huttner & Erin McCreary welcome Prof. David Paterson (Singapore) and Prof. Josh Davis (Newcastle, Australia) to discuss the design and results of the BLING-3 trial, which compared continuous infusion of beta-lactam antibiotics to standard intermittent dosing in 7000 critically ill patients across 104 intensive-care units. In unadjusted analyses, the trial did not show a statistically significant mortality benefit with continuous infusion. Yet in prespecified adjusted analyses, there was a statistically significant reduction in mortality, and a meta-analysis of randomized trials published simultaneously with the BLING-3 trial showed the same. As the two ID doctors on the BLING team, Profs. Paterson and Davis offer context and insights into what these results mean and how they might affect your clinical practice. Episode peer-reviewed by Dr. Mia Lidén of Charité – Universitätsmedizin Berlin. 

Literature

• BLING-1: Dulhunty et al. Continuous infusion of beta-lactam antibiotics in severe sepsis: a multicenter double-blind, randomized controlled trial. Clin Infect Dis. 2013 Jan;56(2):236-44. DOI: 10.1093/cid/cis856
• BLING-2: Dulhunty et al. A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis. Am J Respir Crit Care Med. 2015 Dec 1;192(11):1298-305. DOI: 10.1164/rccm.201505-0857OC
• BLING-3: Dulhunty et al. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. JAMA. 2024 Jun 12:e249779.DOI: 10.1001/jama.2024.9779
• Meta-analysis: Abdul-Aziz et al. Prolonged vs Intermittent Infusions of β-Lactam Antibiotics in Adults With Sepsis or Septic Shock: A Systematic Review and Meta-Analysis. JAMA. 2024 Jun 12:e249803. DOI: 10.1001/jama.2024.9803

What are WHO's most wanted bacterial pathogens in 2024? Hosts Angela Huttner & Oana Sandulescu welcome guests Dr. Hatim Sati of the World Health Organisation (WHO) and Dr. Erin Duffy (CARB-X) to discuss WHO’s new Priority Pathogens List. Developed by WHO and a panel of global experts, the List identifies the ‘top’ bacteria for which research & development are of critical, high, and medium priority, and thus serves as a framework for resource allocation and public-policy guidance. Episode peer-reviewed by Dr. Galadriel Pellejero of Lozano Blesa Clinical Hospital, Zaragoza, Spain. 

Literature:

WHO bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance.

https://www.who.int/publications/i/item/9789240093461

In this episode, hosts Josh Davis (Newcastle, Australia) and Angela Huttner (Geneva, Switzerland) interview the phage ‘microbiologist-clinician duo’, Drs. Shawna McCallin and Lorenz Leitner (Balgrist Hospital, Zurich, Switzerland). They explore the history of phages, the process of bringing phage therapy to a patient, potential resistance to phages, availability of individualized therapy versus phage cocktails, and the place of phage therapy in the future. Drs. Leitner and McCallin reflect on the challenges and lessons of their recently published randomized trial comparing phage therapy to antibiotics for urinary tract infection. Episode peer-reviewed by Dr. Olivia Funk of Long Island University. 

Literature

Leitner L, Ujmajuridze A, Chanishvili N et al.  Intravesical bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomised, placebo-controlled, double-blind clinical trial. Lancet Infect Dis. 2021 Mar;21(3):427-436. doi: 10.1016/S1473-3099(20)30330-3. 

CMI Communications editors Angela Huttner, Marc Bonten, and Erin McCreary discuss late-breaker clinical trials presented at ESCMID Global (ECCMID) in Barcelona, providing insights into the trials’ designs, results, and implications. The DOTS trial compared two doses of long-acting dalbavancin to standard of care in patients with complicated S. aureus bacteremia. GAME-CHANGER compared cefiderocol to standard of care for gram-negative infections. PediCAP compared oral step-down therapy with amoxicillin with or without clavulanic acid at shorter durations to the current WHO-recommended standard of five days of intravenous antibiotic therapy in children with severe pneumonia. Additional results from the MULTICAP and CLEEN trials, the CAMERA-2 follow-on in vitro analysis, and the Burkina Faso Escherichia coli transmission study are also discussed. Episode peer-reviewed by Dr. Yousra Kherabi.

On the verge of a post-antibiotic reality, there is an urgent clinical need for new antibiotics. Luckily, new candidates are in the pipeline and older agents are getting a second breath of life through combination therapy. 

In this episode of Communicable, host Erin McCreary invites Dr. Markus Zeitlinger of the University of Vienna (Austria) and scientific expert for the European Medicines Agency (EMA) and Dr. Michael Dudley, president and CEO of Qpex Biopharma, to discuss antimicrobials in the clinical development pipeline.  Together they unpack how the WHO curate the priority list of pathogens and how companies adapt such lists into their antimicrobial development business plans. They also discuss the unique challenges and complexities of developing antibiotics, from return on investments and defining the ‘novelty’ of an agent to the conundrum of balancing post-market approval and antimicrobial stewardship. Beta-lactamase inhibitors and oral carbapenems in the pipeline targeting ‘the big three’ (Enterobacterales, Pseudomonas and Acinetobacter) are the primary focus.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Benjamin Berinson of the Medical Centre Hamburg-Eppendorf (UKE), Germany. For more information on the WHO Priority Pathogens List and its 2024 update, check out our previous episode, Communicable E3 (see Literature). 

Literature 

Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? 17 June 2024. https://communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first 

WHO Bacterial Priority Pathogens List, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: World Health Organization; 17 May 2024. https://www.who.int/publications/i/item/9789240093461 

C. Le Terrier et al, NDM-9 resistance to taniborbactam. Lancet Infect Dis 23, 401-402 (2023). doi 10.1016/S1473-3099(23)00069-5     

P. B. Eckburg et al, Oral Tebipenem Pivoxil Hydrobromide in Complicated Urinary Tract Infection. N Engl J Med 386, 1327-1338 (2022). doi: 10.1056/NEJMoa2105462 

A Study of Oral Tebipenem Pivoxil Hydrobromide (TBP-PI-HBr) Compared to Intravenous Imipenem-cilastatin in Participants With Complicated Urinary Tract Infection (cUTI) or Acute Pyelonephritis (AP) (PIVOT-PO). https://clinicaltrials.gov/study/NCT06059846

Meiji Seika Pharma Initiated the Global Phase III Clinical Trials of OP0595, a Novel beta-Lactamase Inhibitor for Combatting Antimicrobial Resistance (AMR). Tokyo: Meiji Seika Pharma Ltd; 26 April 2023. https://www.meiji.com/global/news/2023/pdf/230426_01.pdf

Carbapenemase producers are a nightmare for clinicians. Not only are they resistant to carbapenems, a last resort β-lactam antibiotic, they are notorious for developing multidrug and pandrug resistances resulting in limited to no treatment options.  In this episode of Communicable, hosts Angela Huttner and Thomas Tängdén sit down with Dr. David Paterson (National University of Singapore) and Dr. Souha Kanj (American University of Beirut Medical Center, Lebanon), two ID physicians from regions where carbapenem-resistant Enterobacteriaceae or CRE, and carbapenem-resistant Acinetobacter are widespread.  The episode begins with the history and emergence of CRE and reviews current epidemiology, diagnosis (including the Ambler classification of β-lactamases) and treatment options. Lessons and insights from personal experiences are shared to reflect the current clinical challenges caused by carbapenem-resistant bacteria and the importance of infection prevention and control measures to mitigate further spread.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Filippo Medioli of Policlinico di Modena, Italy. For more related content on the WHO Priority Pathogens List and new antibiotics in the pipeline, check out our previous episodes, Communicable E3 and E10 (see Literature).

Literature 

Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? June 2024. https://communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first 

Communicable E10 - Pipeline update: new antibiotics & other antimicrobials that you might actually use. Sep 2024. https://communicable.transistor.fm/episodes/communicable-e10-pipeline-update-new-antibiotics-other-antimicrobials-that-you-might-actually-use 

Wagenlehner FM, et al. Cefepime-Taniborbactam in Complicated Urinary Tract Infection. N Engl J Med 2024 Feb. doi: 10.1056/NEJMoa2304748

Cohn J, et al. Accelerating antibiotic access and stewardship: a new model to safeguard public health. Lancet Infect Dis 2024 Sep. doi:  10.1016/S1473-3099(24)00070-7

Timsit JF, et al. When should I start broad-spectrum antibiotics? Intensive Care Med 2024 Sep. doi: 10.1007/s00134-024-07654-7 

Paterson DL. Antibacterial agents active against Gram Negative Bacilli in phase I, II, or III clinical trials. Expert Opin Investig Drugs 2024 Apr. doi: 10.1080/13543784.2024.2326028 

Substandard and falsified (SF) antimicrobials are a neglected global health problem and have been implicated as drivers of antimicrobial resistance (AMR). Substandard medicines are authorized medical products that fail to meet either their quality standards or their specifications, whereas falsified medicines are those that deliberately and fraudulently misrepresent their identity, composition or source. Host Angela Huttner is joined by Pernette Bourdillon Esteve, Technical Officer for the World Health Organization’s Substandard/falsified Medical Products group, and Ben Cooper, epidemiologist at Oxford University and head of its Drug-Resistant Infection and Disease Dynamics (DRIaDD), to explore the effects of SF antimicrobials on people and AMR.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Arjana Zerja of Mother Teresa University Hospital in Tirana, Albania.

Literature

Cavany S et al.  Nat Commun 14, 6153 (2023). doi: 10.1038/s41467-023-41542-w

WHO Global Surveillance and Monitoring System for substandard and falsified medical products (2017). https://www.who.int/publications/i/item/9789241513425 

The market of predatory publishing is as lucrative as it is unethical. Predatory journals are disguised as legitimate entities, and prey on both early-career academics and the naïve. In this episode of Communicable, hosts Angela Huttner and Marc Bonten are joined by Editors-in-chief Ursula Hofer (Lancet Infect Dis) and Leonard Leibovici (CMI) to discuss the various schemes of the ‘Wild West’ of publishing, and how to avoid them. 

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Özlem Türkmen Recen, Izmir Public Health Laboratory, Izmir, Türkiye.

Literature 

Research4Life https://www.research4life.org/ 

Benedictus R et al. Nature 2016 https://www.nature.com/articles/538453a

Enterococci are commensal microbes, part of the healthy microflora populating the human gut. But they are also opportunistic pathogens and notorious nosocomial agents with intrinsic traits that promote their pathogenesis and make them difficult to kill. In the third instalment of the Nightmare Series, hosts Angela Huttner and Thomas Tängdén are joined by enterococcal experts Kimberly Kline (University of Geneva) and Louis Rice (Brown University) to discuss what make vancomycin-resistant enterococci, or VRE, such a clinical nightmare. Enterococcus faecalis and Enterococcus faecium are the focus.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Nunzia Esposito of the University of Naples Federico II, Naples, Italy.

Literature 

Stellfox ME et al. J Antimicrob Chemother 14 Feb 2024. doi: 10.1128/mbio.03396-23 

Rogers R & Rice LB. Clin Infect Dis 15 Jan 2024. doi: 10.1093/cid/ciad613

Lebreton F et al. Cell 18 May 2017. doi: 10.1016/j.cell.2017.04.027

Donskey CJ et al. N Engl J Med 28 Dec 2000. doi: 10.1056/NEJM200012283432604

Wastewater surveillance is a powerful epidemiological tool that “mirrors our life,” and has gained wide attention in recent years due to its application during the COVID-19 pandemic. The hosts this week, Drs. Navaneeth Narayanan and Emily McDonald, are joined by two wastewater surveillance experts, Dr. Nasreen Hassoun-Kheir of Geneva University Hospitals, a WHO Collaborating Centre on antimicrobial resistance (AMR), as well as Professor David Graham of Newcastle University, United Kingdom, to discuss how this surveillance method—as well as a multidisciplinary approach—are central to understanding community health, infection control and pandemic preparedness.

This episode was edited by Kathryn Hostettler and peer reviewed by Dr. James Donnelly of the Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.

Literature

UN Environment Programme (UNEP), Bracing for superbugs (2023) https://www.unep.org/resources/superbugs/environmental-action 

Hassoun-Kheir N, et al. EMBRACE-WATERS statement (2021). doi:10.1016/j.onehlt.2021.100339

Hassoun-Kheir N, et al. Systematic review (2020). doi: 10.1016/j.scitotenv.2020.140804

Trask JD, et al. (1942). https://pmc.ncbi.nlm.nih.gov/articles/PMC2135222/

Chapters

• (00:00) - Introduction
• (03:03) - Icebreaker question
• (08:33) - What is wastewater surveillance (WWS)?
• (12:47) - How does WWS relate to infection surveillance?
• (16:57) - WWS & pandemic preparedness
• (21:09) - Is the data accessible to the public?
• (25:10) - WWS uses in healthcare settings & mass health: what it can and cannot answer
• (43:00) - What's next for WWS: experts' picks
• (48:33) - Take-home messages

The last episode of the year carries a special end-of-year message from the CMI Comms editors and replays the very first episode of Communicable aired on 10 May 2024, in which editors Angela Huttner, Marc Bonten, and Erin McCreary discuss late-breaker clinical trials presented at ESCMID Global 2024 in Barcelona, providing insights into the trials’ designs, results, and implications. The DOTS trial compared two doses of long-acting dalbavancin to standard of care in patients with complicated S. aureus bacteraemia. GAME-CHANGER compared cefiderocol to standard of care for Gram-negative infections. PediCAP compared oral step-down therapy with amoxicillin with or without clavulanic acid at shorter durations to the current WHO-recommended standard of five days of intravenous antibiotic therapy in children with severe pneumonia. Additional results from the MULTICAP and CLEEN trials, the CAMERA-2 follow-on in vitro analysis, and the Burkina Faso Escherichia coli transmission study are also discussed. This episode was peer-reviewed by Dr. Yousra Kherabi (Clinical Trials Research Section, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris; and Université Paris Cité, Inserm, IAME, Paris, France).

The topic of climate change can engender a ‘doom and gloom’ narrative, as many climate and health consequences are already manifesting. Our host, Dr. Navaneeth Narayanan is joined by two ID physicians passionate about climate change and sustainable clinical practice, Dr. Shreya Doshi (Washington DC, US) and Dr. Laura Jung (Leipzig, Germany). Together they discuss new trends in infectious diseases observed in clinical practice as a direct consequence of climate change, including how tropical diseases are not so tropical anymore. They also outline ways individual clinicians and hospitals can be more sustainable and offer additional resources for the listeners (see below).  

This episode was edited by Kathryn Hostettler and peer reviewed by Dr. Loora Grünvald of the University of Tartu, Estonia. 

Literature

• Mora C et al. Nat Clim Chang (2022). doi: 10.1038/s41558-022-01426-1
• Doshi S et al. J Pediatric Infect Dis Soc (2023). doi: 10.1093/jpids/piae029
• Hofmeister RJ et al. OFID (2024). doi: 10.1093/ofid/ofae368 
• Judson SD et al. OFID (2024). doi: 10.1093/ofid/ofae691
• Jung L et al. Lancet Planet Health (2023). 10.1016/S2542-5196(22)00253-4
• UN General Assembly High-Level Meeting on antimicrobial resistance 2024 https://www.who.int/news-room/events/detail/2024/09/26/default-calendar/un-general-assembly-high-level-meeting-on-antimicrobial-resistance-2024 

 Additional resources

• Lancet countdown on health and climate change  https://www.thelancet.com/countdown-health-climate
• Medicine for a changing planet https://www.medicineforachangingplanet.org/
• Rx for climate https://www.rxforclimate.org/

Communicable returns to the topic of gender dynamics in medicine in the second half of this special. This round, Angela Huttner wants to hear from the men, CMI Comms editors Marc Bonten, Josh Davis, Navaneeth Narayanan and Thomas Tängdén, about tackling issues like the evolving expectations at home and work, the impact of parental-leave policies, and the systemic biases that continue to shape careers. Personal anecdotes and reflections highlight both the progress made and the hurdles that still exist in striving for true gender equity in the medical profession. Editors Erin McCreary and Annie Joseph of CMI Comms also participate in the discussion, with Annie sharing an interesting follow-up to her story told in part 1.

In honour of International Women's Day, Communicable releases the first of a two-part special on gender dynamics within the fields of infectious diseases and clinical microbiology. Moderated by Angela Huttner, part 1 focuses on the women's perspectives, featuring CMI Comms editors Erin McCreary, Annie Joseph, and Huttner herself, who together reflect on personal experiences of gender bias in the workplace. They discuss differential (mis)treatment, break down common gendered situations in the workplace, and explore what individuals, institutes and society can do to promote a more inclusive, supportive environment for all. Editors Marc Bonten, Josh Davis, Navaneeth Narayanan and Thomas Tängdén of CMI Comms also join for part 1.

Several publications have described wondrous therapeutic effects of faecal microbiota transplant (FMT) on Clostridioides difficile infection. Yet the recent randomised trial assessing FMT in US veterans was terminated early for futility. In this episode, hosts Angela Huttner and Marc Bonten delve into the history, application, and complexities of FMT with experts Maria Vehreschild (Frankfurt University Hospital, Germany) and Dimitri Drekonja (Minneapolis Veteran Affairs Care System and University of Minnesota, US), who led the US trial. From the regulatory challenges and trial nuances to important new research, this conversation sheds light on a potentially revolutionary yet controversial treatment. 

Episode was edited by Kathryn Hostettler and peer-reviewed by Arjana Zerja (Mother Theresa University Hospital Centre, Tirana, Albania).

Other mentions:

• EurFMT
• European Directorate for the Quality of Medicines & HealthCare. Guide to the quality and safety of tissues and cells for human application. vol. 5th ed. EDQM Council of Europe; 2022. https://freepub.edqm.eu/publications/17/detail 

Literature

• Drekonja DM et al (2024) Clin Infect Dis, doi: 10.1093/cid/ciae467

Despite being preventable and curable, tuberculosis remains a major global health threat, infecting over 10 million people and claiming more than 1 million lives every year. In this episode of Communicable, hosts Angela Huttner and Navaneeth Narayanan discuss tuberculosis with experts Lorenzo Guglielmetti of Doctors without Borders and Olha Konstantynovska of Kharkiv National University, Ukraine. Key topics include the history, transmission, and pathophysiology of tuberculosis, as well as current diagnostic challenges and treatments for drug-resistant strains. The conversation highlights Lorenzo's work on the endTB project and Olha's experiences managing tuberculosis during the war in Ukraine. Despite advancements in treatment, the episode underscores the urgent need for political will and funding to combat this global health threat.

This episode was edited by Kathryn Hostettler and peer reviewed by Dr. Maria Ana de Quadros Flores e Santos of Unidade Local de Saude Santa Maria, Lisbon, Portugal.

Abbreviations and terminology used in this episode:

• MSF: Médecins sans Frontières, or Doctors without Borders (msf.org)
• FIND: Foundation for Innovative New Diagnostics (www.finddx.org)
• ‘Intoxication symptoms’ are synonymous with ‘constitutional symptoms’ or ‘B symptoms’ of tuberculosis and include fever, night sweats, and unintentional weight loss. 

Literature:

• endTB Project
• Annual global tuberculosis report by WHO 2024 
• Dorman SE, et al. Four-Month Rifapentine Regimens with or without Moxifloxacin for Tuberculosis. N Engl J Med 2021 doi: 10.1056/NEJMoa2033400
• Guglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. N Engl J Med 2025 doi: 10.1056/NEJMoa2400327

Sexually transmitted infections (STIs) affect millions globally daily, and multidrug-resistant strains are complicating treatment. Hosts Angela Huttner and Josh Davis welcome experts Dr. Teodora Elvira Wi from WHO and Professor Catriona Bradshaw from Monash University to discuss critical issues surrounding ‘super gonorrhoea,’ chlamydia, syphilis, Mycoplasma genitalium, and bacterial vaginosis. The episode reviews the latest epidemiology and highlights the need to innovate diagnostics and treatment options, destigmatise STIs, and promote people-centred healthcare strategies to manage and prevent these infections. 

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Arjana Zerja of Mother Theresa University Hospital Centre, Tirana, Albania.  

Literature:

Guidelines for the management of symptomatic sexually transmitted infections. Geneva: World Health Organization; 2021.

Chris Kenyon et al. on screening impact for gonorrhoea and chlamydia infections in key populations The Lancet HIV 2024.

Rising anti-vaccine sentiment and dissemination of misinformation are threats to public health. In the US, calls to revoke certain public health mandates have been proposed by likely members of the incoming administration, among them vaccination against polio. The fourth instalment of the Nightmare Series is both a cautionary tale and an effort to preserve and share clinical expertise on how to diagnose and manage polio and rubella in a world where, until now, few doctors have had to face these illnesses in the clinical setting. Host Angela Huttner welcomes Professor Emeritus of Infectious Diseases Bernard Hirschel at the University of Geneva and Dr. Kerrigan McCarthy of the Centre for Vaccines and Immunology at South Africa’s National Institute for Communicable Diseases (NICD) for that discussion.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Barbora Píšová in Antwerp, Belgium.

Literature

Link-Gelles R et al (2022) MMWR https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e2.htm 

Ryerson AB et al (2022) MMWR https://www.cdc.gov/mmwr/volumes/71/wr/mm7144e2.htm 

Kasstan B et al (2023) Epidemiol Infect doi: 10.1017/S0950268823001127

NICD (2024) Report: Rubella in South Africa, 2024.

https://www.nicd.ac.za/surge-in-rubella-cases-in-south-africa-november-2024/

ESCMID Global, ESCMID’s flagship congress, kicks off this Friday in Vienna. In light of that, Angela Huttner and Thomas Tängdén sit down with ESCMID leadership, President Robert Skov and Immediate-Past President Annelies Zinkernagel in this episode of Communicable. Together they discuss the roles of medical societies like ESCMID in shaping healthcare policy, the importance of scientific communication, and lessons learned from the COVID pandemic. The conversation highlights ESCMID’s priorities for the future on addressing antimicrobial resistance, fostering international collaboration and new educational initiatives. The episode also features personal anecdotes about what makes coming together at ESCMID Global so special. Tune in for a comprehensive look at how ESCMID is championing medical progress in infection for a healthier tomorrow.

This episode was edited by Kathryn Hostettler and not peer reviewed.

References

• Global impact of US policy changes: The ESCMID perspective. CMI Comms 2025;2(2): 105073.
• Malani AN, Sharland M, Clancy CJ, Skov R, ESCMID & IDSA Executive Boards. A global call to action to fight antimicrobial resistance: IDSA and ESCMID joint white paper. CMI Comms 2024; 1(2): 105033.
• Baghdadi JD & Morgan DJ. Diagnostic tests should be assessed for clinical impact. CMI Comms 2024; 1(2): 105010.

In this episode of Communicable, hosts Angela Huttner and Annie Joseph join experts Kerrigan McCarthy of South Africa’s National Institute for Communicable Diseases and Natasha Crowcroft of the World Health Organisation to discuss the resurgence of measles as a consequence of misinformation campaigns and waning vaccination rates, how to diagnose and manage active measles cases, and post-exposure control measures to take to reduce further spread. They also address the broader challenges of the moment, including generalised vaccine hesitancy and sudden, sweeping budget cuts, underscoring the message that “measles anywhere is a problem everywhere.”

This episode was edited by Kathryn Hostettler and peer reviewed by Dr. Anelia Zasheva of the Military Medical Academy, Sofia, Bulgaria.

In this first-ever collaboration between Communicable and Breakpoints, the podcast of the US Society of Infectious Diseases Pharmacists, hosts Angela Huttner (Geneva, Switzerland) and Erin McCreary (Pittsburgh, USA) join trial investigators Josh Davis (Newcastle, Australia) and Steve Tong (Melbourne, Australia) to unpack the first results coming from the SNAP adaptive platform trial, which were recently presented at ESCMID Global in Vienna. Learn whether penicillin and cefazolin are non-inferior to—and maybe even safer than—flucloxacillin for penicillin-susceptible and methicillin-susceptible Staphylococcus aureus, respectively.

This episode was edited by Julie Anne Justo, transcribed by Katie Lambert and Sarah Groome, and peer-reviewed by Megan Klatt and Lacy Worden. 

Note on conflict of interest for SNAP Data Safety Monitoring Committee (DSMC) members:

Conflicts of interest were evaluated when choosing individuals to serve on the SNAP DSMC. Aside from being compensated for their duties on the committee, DSMC members have no ongoing financial relationships that relate to the trial and are not involved in the conduct of the trial in any role other than that of a DSMC member. DSMC members have no intellectual conflict of interest or bias and reviewed SNAP data in a fully objective manner. 

Literature:

Steven Y. C. Tong, Joshua S. Davis, Emily Eichenberger et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015 Jul;28(3):603-61.

SNAP Adaptive trial platform/results of the PSSA & MSSA domains: 

• https://www.snaptrial.com.au/

ESCMID Global April 2025 presentation:

• www.online.escmid.org *
• https://www.escmid.org/congress-events/escmid-global/programme/scientific-programme/

CloCeBa trial results (ESCMID Global April 2025 presentation): 

• www.online.escmid.org *
• https://www.escmid.org/congress-events/escmid-global/programme/scientific-programme/

Note on access to online video of ESCMID Global presentations:

• In the six months following the congress:
  • Non-ESCMID members have access if they registered for ESCMID Global
  • Members have access only if they registered for ESCMID Global
• Six months after the congress:
  • Non-members do not have access, whatever their ESCMID Global registration status
  • All members have access, whatever their ESCMID Global registration status

CAMERA 2 trial: Steven Y. C. Tong, David C. Lye, Dafna Yahav, et al. Without an Antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA BacteremiaA Randomized Clinical Trial. JAMA. 2020;323(6):527-537. doi:10.1001/jama.2020.0103

 
POET trial: Kasper Iversen, Nikolaj Ihlemann, Sabine U. Gill et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med 2019;380:415-424

POET trial follow-up: Mia M. Pries-Heje, Christoffer Wiingaard, Nikolaj Ihlemann. Five-Year Outcomes of the Partial Oral Treatment of Endocarditis (POET) Trial. N Engl J Med 2022;386:601-602

This episode of Communicable takes on a special format where editors of CMI Comms, Marc Bonten, Josh Davis, Erin McCreary, Emily McDonald, all clinical trialists in their own right, take turns to summarise and discuss late-breaker trials presented at ESCMID Global 2025 in Vienna. These include the CloCeBa trial on Staphylococcus aureus bacteraemia treatment options, the Taper V trial on vancomycin as prophylaxis for Clostridioides difficile infection, the ASTARTÉ trial on temocillin versus meropenem for bacteraemia due to third-generation cephalosporin-resistant Enterobacterales, the HARVEST trial investigating high doses of rifampicin for tuberculosis meningitis, and the CAP5 trial on shortening antibiotic treatment for community-acquired pneumonia. 
 
This episode was peer reviewed by Dr. Barbora Píšová (Czech Republic) and is the first of a two-part series covering selected clinical trials presented at ESCMID Global 2025. 

References: 

• Lescure X, et al. Cloxacillin versus cefazolin for methicillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa): a randomised, controlled, non-inferiority trial
• McDonald EG, et al. Initial vancomycin taper for the prevention of recurrent Clostridioides difficile infection: the TAPER-V randomised controlled trial
• Cogliati Dezza F, et al. Temocillin versus meropenem for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistant Enterobacterales (ASTARTÉ): a randomised, pragmatic trial
• Van Crevel R, et al. High-dose rifampicin in the treatment of tuberculous meningitis: results of the HARVEST phase III multi-country randomised clinical trial
• Bastrup Israelsen S, et al. Shortened antibiotic treatment for 5 days in patients hospitalised with community-acquired pneumonia (CAP5): a multicentre randomised controlled noninferiority trial

Editors of CMI Comms, Josh Davis, Erin McCreary and Emily McDonald return for round 2 taking turns to summarise and discuss late-breaker trials presented at ESCMID Global 2025 in Vienna, and whether or not these trials should change your practice. Part 2 covers the ALABAMA trial exploring the safety of penicillin-allergy delabelling using the penicillin allergy assessment pathway, the SOLARIO trial investigating short (≤7 days!) versus long (≥4 weeks) antibiotic courses for orthopaedic infections, the EAGLE-1 trial assessing oral gepotidacin for gonorrhoea, a randomised clinical trial (RCT) from Thailand on oral fosfomycin as carbapenem-sparing, de-escalating therapy in complicated UTIs, and a double-blind RCT from Israel comparing neutralising plasma to placebo for West Nile fever.   
 
This episode was peer reviewed by Dr. Emanuele Rando of Hospital Universitario Virgen Macarena, Seville, Spain and is the second of this two-part series covering selected clinical trials presented at ESCMID Global 2025. 
 
Late-breaker trials

• Sandoe J, et al. Penicillin allergy assessment pathway versus usual clinical care for primary care patients with a penicillin allergy record to assess safety, de-labelling and antibiotic prescribing: The ALABAMA randomised controlled trial
• Angkanavisan K, et al. Oral fosfomycin after carbapenems as de-escalating therapy in complicated urinary tract infection: A randomised
  controlled trial
• Canetti M, et al. Neutralising plasma versus placebo for hospitalised patients with West Nile fever: a double-blind randomised controlled trial
• Dudareva M, et al. Short or long antibiotic regimes in orthopaedics: the SOLARIO multicentre randomised controlled trial
• Wilson, J. Phase 3 randomised trial of oral gepotidacin for the treatment of uncomplicated gonorrhoea (EAGLE-1) 

References

• IDSA. Public Comment: IDSA Guideline on Management and Treatment of Complicated Urinary Tract Infections; 19 Feb - 19 March 2025.
• Mostashari F, et al. Epidemic West Nile encephalitis, New York, 1999. Lancet. 2001. doi: 10.1016/S0140-6736(01)05480-0
• Angus DC. Optimizing the Trade-off Between Learning and Doing in a Pandemic. JAMA. 2020. doi: 10.1001/jama.2020.4984
• Dudareva M. In: The 42nd Annual Meeting of the European Bone & Joint Infection Society. Barcelona, Spain: 26-28 Sept 2024. 
• Li HK, et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA). NEJM. 2019 doi: 10.1056/NEJMoa1710926

Bacterial vaginosis (BV) was long considered not to be a sexually transmitted infection (STI), and treatment was only for women to bear. That was the convention at least until Catriona Bradshaw and her team at the Melbourne Sexual Health Centre published their groundbreaking clinical trial results earlier this year, demonstrating that treating male partners of women with BV prevented recurrence in those women. In this episode of Communicable, hosts Angela Huttner and Annie Joseph welcome back Bradshaw to discuss her trial’s design, results, and clinical implications—with some guidelines already updated to include male partners in BV treatment regimens. The conversation also explores the complexities of BV diagnosis, the challenges of trial execution in general, and future research directions.

This episode was edited by Kathryn Hostettler and peer reviewed by Arjana Zerja (Mother Theresa University Hospital Centre, Tirana, Albania)

References

1. Vodstricil LA, et al. Male-partner treatment to prevent recurrence of bacterial vaginosis. N Engl J Med 2025. DOI: 10.1056/NEJMoa2405404
2. Bacterial vaginosis in focus. Melbourne Sexual Health Centre (MSHC). https://www.mshc.org.au/sexual-health/bacterial-vaginosis

Further reading

• Auvert B, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2005. DOI: 10.1371/journal.pmed.0020298
• Bailey RC, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007. DOI: 10.1016/S0140-6736(07)60312-2
• Bukusi E, et al. Topical penile microbicide use by men to prevent recurrent bacterial vaginosis in sex partners: A randomized clinical trial, Sex Transmi Dis 2011. DOI: 10.1097/OLQ.0b013e318214b82d
• Cohen CR, et al. Randomized trial of Lactin-V to prevent recurrence of bacterial vaginosis. N Engl J Med 2020. DOI: 10.1056/NEJMoa1915254
• Gray RH, et al. The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda, Am J Obstet Gynecol 2009. DOI: 10.1016/j.ajog.2008.07.069
• King AJ, et al. Getting Everyone on Board to Break the Cycle of Bacterial Vaginosis (BV) Recurrence: A Qualitative Study of Partner Treatment for BV. Patient 2025. DOI: 10.1007/s40271-025-00731-z
• Mehta S, et al. The microbiome composition of a man's penis predicts incident bacterial vaginosis in his female sex partner with high accuracy, Front Cell Infect Microbiol 2020. DOI: 10.3389/fcimb.2020.00433
• Muzny CA, et al. An Updated Conceptual Model on the Pathogenesis of Bacterial Vaginosis. J Infect Dis 2019 DOI: 10.1093/infdis/jiz342
• Mitchell CM, et al. Screening and characterization of vaginal fluid donations for vaginal microbiota transplantation, Sci Rep 2022. DOI: 10.1038/s41598-022-22873-y
• Plummer EL, et al. A Prospective, Open-Label Pilot Study of Concurrent Male Partner Treatment for Bacterial Vaginosis. mBio 2021. DOI: 10.1128/mBio.02323-21
• Plummer EL, et al. Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: Acceptability, tolerability and impact on the genital microbiota of couples - A pilot study. PLoS One 2018. DOI: 10.1371/journal.pone.0190199
• Vodstrcil LA, et al. Bacterial vaginosis: drivers of recurrence and challenges and opportunities in partner treatment. BMC Med 2021. DOI: 10.1186/s12916-021-02077-3
• Wawer MJ, et al. Wawer MJ, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: A randomised controlled trial. Lancet 2009. DOI: 10.1016/S0140-6736(09)60998-3

Fungal infections and disease have long been overlooked in terms of healthcare burden, with poor diagnostics and limited options for treatment and management. In 2022, the WHO published its first Fungal Priority Pathogens List as an effort to establish a global prioritised framework that addresses unmet research and development needs in fungal disease and antifungal resistance, as well as guides public health action [1]. In this episode of Communicable, Angela Huttner and Josh Nosanchuk invite Hatim Sati (WHO), the project lead in creating this list, and Dimitrios Kontoyiannis (MD Anderson Cancer Center, Houston, Texas), a clinician researcher studying fungal diagnostics and antifungal discovery, for a candid discussion on the making of and relevance of such a list. Apart from reviewing the fungal pathogens, the conversation also covers limitations of the list, what to expect for the next iteration, contextualising the list in one’s local region, and the impact the list has had already on research funding and public awareness.

This episode was edited by Kathryn Hostettler and peer reviewed by Andrisa Xhaxha from Elbasan, Albania. 

References

1. WHO fungal priority pathogens list to guide research, development and public health action. Geneva: World Health Organization; 2022. 

Related podcast episodes

• Communicable Episode 31: Climate change and fungal spread https://share.transistor.fm/s/db58f558 
• Communicable Episode 08: The nightmare series, part 1 – how to deal with Candida auris https://share.transistor.fm/s/c0616c4d 

Further reading 

• Seidel D, et al. Impact of climate change and natural disasters on fungal infections. Lancet Microbe 2024. DOI: 10.1016/S2666-5247(24)00039-9
• Fisher MC and Denning DW. The WHO fungal priority pathogens list as a gamechanger. Nat Rev Microbiol 2023. DOI: 10.1038/s41579-023-00861-x
• Shor E, et al. Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions. mSphere 2025. DOI: 10.1128/msphere.00161-25
• Panackal AA, et al. Geoclimatic influences on invasive aspergillosis after hematopoietic stem cell transplantation. Clin Infect Dis 2010. DOI: 10.1086/652761
• Lázár-Molnár E, et al. The PD-1/PD-L costimulatory pathway critically affects host resistance to the pathogenic fungus Histoplasma capsulatum. PNAS 2008. DOI: 10.1073/pnas.0711918105
• Mashal M, “A potentially fatal fungal infections cropping up among India’s Covid patients.” New York Times 2021. https://www.nytimes.com/2021/05/09/world/india-covid-mucormycosis.html 
• Thevissen K, et al. International survey on influenza-associated pulmonary aspergillosis (IAPA) in intensive care units: responses suggest low awareness and potential underdiagnosis outside Europe. Crit Care 2020. DOI: 10.1186/s13054-020-2808-8
• Pappas PG, et al. Clinical mycology today: A synopsis of the mycoses study group education and research consortium (MSGERC) second biennial meeting, September 27–30, 2018, Big Sky, Montana, a proposed global research agenda. Medical Mycology 2020. DOI: 10.1093/mmy/myaa034
• Hostettler K, et al. Communicable Episode 31: Climate change and fungal spread. CMI Communications 2025. DOI: 10.1016/j.cmicom.2025.105126

Ethics in the field of infectious disease can be a delicate interplay between treating the individual patient and protecting the collective health of a society. Sometimes these two mandates go hand in hand; at other times they can appear to be in conflict. In this episode of Communicable, Dr. Angela Huttner invites Drs. Zeb Jamrozik (Melbourne, Australia) and Beenish Syed (Karachi, Pakistan), two members of ESCMID’s Ethics Advisory Committee, to unpack different scenarios encountered in the field of infectious disease from an ethics standpoint: how one ethically allocates scarce resources like antimicrobials; whether there is ethical justification for coercive public-health measures like lockdowns; and whether the need to collect evidence to advance patient care could include other models besides opt-in informed consent. 

This episode was edited by Dr. Kathryn Hostettler and peer reviewed by Dr. Goulia Ohan of Yerevan State Medical University, Yerevan, Armenia.

Further reading:

• Barosa M, et al. The Ethical Obligation for Research During Public Health Emergencies: Insights From the COVID-19 Pandemic. Med Health Care Philos 2024. DOI: 10.1007/s11019-023-10184-6
• Symons X, et al. Why should HCWs receive priority access to vaccines in a pandemic? BMC Med Ethics 2021. DOI: 10.1186/s12910-021-00650-2
• Thorsteinsdottir B and Madsen BE. Prioritizing health care workers and first responders for access to the COVID19 vaccine is not unethical, but both fair and effective – an ethical analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2021. DOI: 10.1186/s13049-021-00886-2
• Huttner A, Leibovici L, Theuretzbacher U, Huttner B, Paul M. Closing the evidence gap in infectious disease: point-of-care randomization and informed consent. Clin Microbiol Infect 2017;23(2):73-77. DOI: 10.1016/j.cmi.2016.07.029

Fluoroquinolones (FQs) are valuable given their broad-spectrum activity against Gram-positive and Gram-negative bacteria and their high penetration into various tissues. Yet FQs have also caused concern, with some market withdrawals, important and sometimes long-lasting adverse drug events, and substantial collateral effects on the microbiota. In this episode of Communicable, hosts Emily McDonald and Thomas Tängdén invite Staffan Tevell (Karlstad, Sweden) and Bernadette Young (Oxford, UK) to weigh in on the pro-con debate of FQ use, especially for periprosthetic joint infections (PJIs), which can entail longer treatment durations. They review the standard of care for PJIs, including FQs in combination with rifampicin vs other antibiotic combinations, the impact of the OVIVA trial advocating for early oral switch strategies, the long list of rare but important side effects, and how best to preserve FQs for clinical indications that most need them.     

This episode is a follow-up from Tevell and Young’s recently published systematic review of the role of FQs in PJIs [1]. It was edited by Kathryn Hostettler and peer reviewed by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. The executive producer of Communicable is Angela Huttner. 

References

1. Tevell S, et al. To heal or harm: A systematic review of the role of fluoroquinolones in periprosthetic joint infections. CMI Communications 2025. DOI: 10.1016/j.cmicom.2025.105103

Further reading

• Mandell LA, et al. Antimicrobial Safety and Tolerability: Differences and Dilemmas. Clin Infect Dis 2001. JSTOR http://www.jstor.org/stable/4461522.
• Pham TDM, et al. Quinolone antibiotics. Medchemcomm 2019. DOI: 10.1039/c9md00120d. 
• Rodrigues CF and Silva F. The Rise, Fall, and Rethink of (Fluoro)quinolones: A Quick Rundown. Pathogens 2025. DOI: 10.3390/pathogens14060525
• Slimings C and Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother 2014. DOI: 10.1093/jac/dkt477
• Davis JS, et al. Predictors of treatment success after periprosthetic joint infection: 24-month follow up from a multicenter prospective observational cohort study of 653 patients. Open Forum Infect Dis 2022. DOI: 10.1093/ofid/ofac048.
• Grossi O, et al. Gram- negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones. J Antimicrob Chemother 2016. DOI: 10.1093/jac/dkw202 
• Cortes-Penfield NW, et al. Adjunctive rifampin following debridement and implant retention for staphylococcal prosthetic joint infection: is it effective if not combined with a fluoroquinolone? Open Forum Infect Dis 2022. DOI:  10.1093/ofid/ofac582
• Pushkin R, et al. A Randomized Study Evaluating Oral Fusidic Acid (CEM-102) in Combination With Oral Rifampin Compared With Standard-of-Care Antibiotics for Treatment of Prosthetic Joint Infections: A Newly Identified Drug-Drug Interaction. Clin Infect Dis 2016. DOI: 10.1093/cid/ciw665
• Bock M, et al. Rifampicin reduces plasma concentration of linezolid in patients with infective endocarditis. J Antimicrob Chemother 2023. DOI: 10.1093/jac/dkad316   
• Zeller V, et al. Influence of the clindamycin administration route on the magnitude of clindamycin-rifampicin interaction: a prospective pharmacokinetic study. Clin Microbiol Infect. 2021. DOI: https://doi.org/10.1016/j.cmi.2021.04.017 
• Bernard L, et al. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med 2021. DOI: 10.1056/NEJMoa2020198
• Vollmer NJ, et al. Safety and Tolerability of Fluoroquinolones in Patients with Staphylococcal Periprosthetic Joint Infections, Clin Infect Dis 2021. DOI 10.1093/cid/ciab145
• Gopalakrishnan C, et al. Association of fluoroquinolones with the risk of aortic aneurysm or aortic dissection. JAMA Intern Med 2020. DOI 10.1001/jamainternmed.2020.4199
• Li HK, et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA). N Engl J Med. 2019. DOI: 10.1056/NEJMoa1710926

The adaptability of fungi to warmer temperatures is an obvious consequence of climate change. Perhaps less obvious is the role climate change has played on fungal pathogens emerging as a global health concern. While humans are mostly protected from fungal infections by our immune system and body temperature, a warming global climate could subvert the status quo. Some fungi are already adapted to warmer temperatures and causing invasive acute infections in humans: Candidozyma auris, Cryptococcus neoformans, and Aspergillus fumigatus, to name a few.  In this episode of Communicable, Angela Huttner and Josh Nosanchuk invite Arturo Casadevall, a Bloomberg Distinguished Professor at Johns Hopkins and this year’s recipient of ESCMID’s Excellence in Science Award, to discuss the world of fungi and their pathogenic potential in a warming world. Other topics include how to prepare for their emergence as a health threat, how fungi can be harnessed for applications that can benefit us, and ultimately answering the question Casadevall himself posed in the title of his recently published book, What if fungi win?

This episode was edited by Kathryn Hostettler and peer reviewed by Robin Aerts of University Hospital Antwerp, Belgium. 

References

1.        Casadevall, A with Desmon S. What if fungi win? Johns Hopkins University Press, 2024.

2.        Smith DFG, et al. Environmental fungi from cool and warm neighborhoods in the urban heat island of Baltimore City show differences in thermal susceptibility and pigmentation. BioRxiv 2025. DOI: 10.1101/2023.11.10.566554  

3.        Casadevall A and Pirofski L. Benefits and Costs of Animal Virulence for Microbes. mBio 2019. DOI: 10.1128/mBio.00863-19

4.        Cordero RJB et al. Radiation protection and structural stability of fungal melanin polylactic acid biocomposites in low Earth orbit. PNAS 2025. DOI: 10.1073/pnas.2427118122

5.        Dadachova E, et al. The radioprotective properties of fungal melanin are a function of its chemical composition, stable radical presence and spatial arrangement. Pigment Cell Melanoma Res 2008. DOI: 10.1111/j.1755-148X.2007.00430.x

6.        Cordero RJB et al. The hypothermic nature of fungi. PNAS 2022. DOI: 10.1073/pnas.2221996120

Meningitis remains a major global health threat, with an estimated 2.5 million cases each year; of these, one in six results in death and one in five in long-term disabilities. Although meningitis “can strike anyone, anywhere in the world,” outbreaks disproportionately impact low- and middle-income countries, where diagnostic and treatment resources are limited. In efforts to address this, WHO launched its first-ever guideline on meningitis diagnosis and management in April this year. In this episode of Communicable, hosts Emily McDonald and Marc Bonten are joined by two experts directly involved in creating the guideline, Lorenzo Pezzoli and Nicolò Binello (WHO), as well as Jacob Bodilsen (Aalborg University), clinician-researcher and Chair of ESCMID’s Study Group for Infectious Diseases of the Brain (ESGIB). The guests offer a firsthand look behind the guideline’s development, review key recommendations for diagnosis and treatment - including the use of lumbar puncture, antibiotics, and chemoprophylaxis – and discuss how these fit into various clinical settings. 

This episode was edited by Kathryn Hostettler and peer reviewed by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. The executive producer of Communicable is Angela Huttner. 

Terms

• CRP, C-reactive protein
• GDG, Guideline Development Group

Literature 

1. WHO guidelines on meningitis diagnosis, treatment and care. April 2025. https://www.who.int/publications/i/item/9789240108042
2. Defeating meningitis by 2030: a global road map. June 2021. https://www.who.int/publications/i/item/9789240026407
3. Olie SE, et al. Validation and clinical implementation of cerebrospinal fluid C-reactive protein for the diagnosis of bacterial meningitis: a prospective diagnostic accuracy study. Lancet Reg June 2025. DOI: 10.1016/j.lanepe.2025.101309
4. Coldiron ME, et al. Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial. PloS Med 2018. DOI: 10.1371/journal.pmed.1002593
5. Hasbun R, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001. DOI: 10.1056/NEJMoa010399
6. Glimåker M. Lumbar puncture in adult bacterial meningitis: time to reconsider guidelines? BMJ 2013, DOI: 10.1136/bmj.f361

In this episode of Communicable, Angela Huttner and Erin McCreary invite two titans of vaccinology, Barney Graham (Atlanta, USA), former deputy director of the NIH NIAID Vaccine Research Center and architect of the mRNA vaccines against COVID-19, and Gary Kobinger (Galveston, USA), leading virologist in the development of the first effective Ebola vaccine, rVSV-ZEBOV, for a candid conversation about their direct experience building two of the most well known vaccines to date, and deploying them to the public. The episode also reviews the different vaccine platforms and addresses vaccine hesitancy, equitable access to vaccines, and global health equity. 

This episode was edited by Kathryn Hostettler and peer reviewed by Eren Ozturk of Ankara University, Ankara, Türkiye. 

Terms and sources

• VSV, vesicular stomatitis virus
• ZEBOV, Zaire Ebolavirus 
• rVSV-ZEBOV, recombinant vesicular stomatitis virus expressing the (Zaire) Ebolavirus glycoprotein (vaccine)
• VRC, the NIH Vaccine Research Center of NIAID 
• Morehouse School of Medicine Satcher Global Health Equity Institute
• GuardRX, https://www.guardrx.org/en/who-we-are/ 

References

1. Marzi A, et al. VSV-EBOV rapidly protects macaques against infection with the 2014/15 Ebola virus outbreak strain. Science 2015. DOI: 10.1126/science.aab3920 
2. Agnandji S, Huttner A, Zinser M, et al. Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe. New Engl J Med 2015. DOI: 10.1056/NEJMoa1502924
3. Graham BS and Corbett KS. Prototype pathogen approach for pandemic preparedness: world on fire. J Clin Invest 2020. DOI: 10.1172/JCI139601
4. Jackson LA, Anderson EJ, Rouphael NG, et al. An mRNA Vaccine against SARS-CoV-2 - Preliminary Report. New Engl J Med 2020. DOI: 10.1056/NEJMoa2022483

In this second-ever collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Angela Huttner invite the two principal investigators and visionaries who spearheaded the Bacteraemia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) trial, Nick Daneman and Rob Fowler (Sunnybrook Health Sciences Centre, Toronto), for a “deep dive into all things that went into this trial” (1). The BALANCE trial spanned over ten years investigating - as the acronym title suggests - whether a shorter treatment duration of seven days was non-inferior to the standard of care of fourteen days for bacteraemia. The conversation covers everything from the initial hallway discussions that sparked the trial to the trial itself that screened over 36,000 patients and enrolled +3,600, its key takeaways and its impact on clinical practice as well as what’s next for Daneman and Fowler.

This episode was edited by Kathryn Hostettler and Megan Klatt, and peer reviewed by Dr. Arjana Zerja of Mother Theresa University Hospital Centre, Tirana, Albania.

Related podcast episodes

• Communicable episode 36: Finding BALANCE in antibiotic durations—the BALANCE trial https://share.transistor.fm/s/b680895e
• Communicable episode 26: SNAP out of it—rethinking anti-staphylococcal penicillins for S. aureus bacteremia, the SNAP trial PSSA/MSSA results https://share.transistor.fm/s/2a3c3bb4
• Breakpoints episode covering IDWeek (December 2024) https://breakpoints-sidp.org/108-idweek-2024-recap-late-breaker-abstracts-and-stewardship-talks/ 

References

1. BALANCE Investigators, et al.  Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2025 March. DOI: 10.1056/NEJMoa2404991

Further reading 

• Fowler VG. Eight days a week – BALANCING duration and efficacy. N Engl J Med. 2025 March. DOI: 10.1056/NEJMe2414037   
• Dulhunty JM, et al. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. JAMA 2024. DOI: 10.1001/jama.2024.9779  
• Yahav D, et al. Seven versus 14 days of antibiotic therapy for uncomplicated Gram-negative bactermia: A noninferiority randomized controlled trial. Clin Infect Dis 2018. DOI: 10.1093/cid/ciy1054 
• Von Dach E, et al. Effect of C-reactive protein-guided antibiotic treatment duration, 7-day treatment, or 14-day treatment on 30-day clinical failure rate in patients with uncomplicated Gram-negative bacteremia, a randomized clinical trial. JAMA 2020. DOI: 10.1001/jama.2020.6348 
• Ong SWX, et al. Identifying heterogeneity of treatment effect for antibiotic duration in bloodstream infection: an exploratory post-hoc analysis of the BALANCE randomised clinical trial. EClinicalMedicine 2025. DOI: 10.1016/j.eclinm.2025.103195
• Wallach JD, et al. Evaluation of evidence of statistical support and corroboration of subgroup claims in randomized clinical trials. JAMA Intern Med 2017. DOI: 10.1001/jamainternmed.20169125

Contrary to popular belief, peer review has only recently become an integral step in scientific publishing. Currently seen by many as a badge of honour ensuring valid, innovative and honest research, peer review seems in reality to be increasingly thankless, exploitative, and sometimes invisible. How did we get here? In this episode of Communicable, Annie Joseph and Angela Huttner are joined by two experts, Melinda Baldwin (University of Maryland, USA) and Serge Horbach (Radboud University, Netherlands), to unpack and examine the role of peer review, why it is still essential, and how it fits within the greater editorial process. The conversation covers the history of peer review, contemporary formats including open review and the use of artificial intelligence, and thoughtful discussion on how to fix and rethink peer review. 

This episode was edited by Kathryn Hostettler and peer reviewed by Barbora Píšová from the Czech Republic.

Related podcast episodes 

• Communicable episode 13: The Wild West of publishing today—predatory journals and how to deal with them https://share.transistor.fm/s/e3abe9af 

Resources

• EASE, the European Association of Science Editors https://ease.org.uk/ 
• Peer review week https://peerreviewweek.net/ 

Further reading

• Csiszar, A. The Scientific Journal: Authorship and the Politics of Knowledge in the Nineteenth Century. The University of Chicago Press, 2018. DOI: 10.7208/chicago/9780226553375.001.0001 
• Entradas, Sousa, Yan, et al. (2023) Public Deliberative Workshops – Findings. POIESIS project deliverable D2.2. https://poiesis-project.eu/deliverables/.
• Ross-Hellauer T and Horbach SPJM. Additional experiments required: A scoping review of recent evidence on key aspects of Open Peer Review, Research Evaluation, 2024. DOI: 10.1093/reseval/rvae004
• Horbach SPJM and Halffman W. The changing forms and expectation of peer review. Res Integr Peer Rev 2018. DOI: 10.1186/s41073-018-0051-5
• Danziger S, et al. Extraneous factors in judicial decisions. Proc Natl Acad Sci USA, 2011. DOI: 10.1073/pnas.1018033108
• Fyfe, A., Moxham, N., McDougall-Waters, J., & Røstvik, C. M. (2022). A History of Scientific Journals: Royal Society publishing, 1665-2015. London: UCL Press.
• “Misconduct in Science,” 9 February 1983, NN3-443-UD-12D-1 box 78, file “RES 12 Misconduct in Science, 1983-1987,” Papers of the NIH Director, National Archives and Records Administration, College Park, MD.
• Baldwin M. In Referees We Trust? How Peer Review Became a Mark of Scientific Legitimacy. MIT Press (Open Access). Work in Progress.

In this episode of Communicable, Erin McCreary and Angela Huttner are joined by Barbara Trautner (St. Louis, USA) and Valéry Lavergne (Vancouver, Canada), the co-chairs and leading authors of the first IDSA guideline on complicated urinary tract infection (cUTI), which was published a few months ago [1]. Together, they discuss the process of developing the guideline from its conception in 2018, the new definition of cUTI, their stepwise approach to clinical decision-making, and some case-by-case scenarios for common antibiotics. They also elaborate on how this guideline compares (and contrasts) to other existing UTI guidelines—including the previous IDSA guideline for UTI [2] —and the clinical need to supply frontline clinicians to identify and distinguish complicated cases from the uncomplicated ones. The episode closes with what essential clinical questions the guests hope to tackle next.
 
This episode was edited by Kathryn Hostettler and peer reviewed by Maria Ana Flores of Santa Maria Local Health Unit, Lisbon, Portugal.

Other resources:

• European Urologic Association guidelines
• UpToDate
• FDA guidance on complicated UTI 

References

1. Trautner BW, et al. Clinical Practice Guideline by Infectious Diseases Society of America (IDSA): 2025 Guideline on Management and Treatment of Complicated Urinary Tract Infections 
2. Gupta, K, et al. Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: 2010 Update by IDSA

It’s World AMR Awareness Week (WAAW) and we have prepared a special episode in light of that. In this week's Communicable, Navaneeth Narayanan and Thomas Tängdén host Aula Abbara (London, UK), Guido Granata (Rome, Italy) and Tuomas Aro (Helsinki, Finland) to discuss the phenomenon of AMR in conflict and crisis zones. They elaborate on how difficult conditions and austere environments amplify the spread of AMR, drawing on findings from the ongoing conflicts in Ukraine, Gaza, Syria and other regions. Other topics covered include adapting antimicrobial stewardship and infection prevention and control (IPC) practices as well as the need for genuine political will and international collaboration to end conflicts and their exacerbation on AMR.

This episode follows the webinar “Beyond the frontlines” organised by ESCMID’s AMR Action Subcommittee for WAAW 2025, featuring the same guests, and is available on ESCMID Media. This Communicable episode was peer reviewed by Arjana Zerja of Mother Theresa University Hospital Centre, Tirana, Albania. 

Related ESCMID and Communicable media

• ESCMID Media, Part 1: Beyond the frontlines - tackling AMR in conflict and crisis zones, webinar 
• Communicable episode 11: Nightmare series, part 2 – how to deal with carbapenemase producers 
• Communicable episode 16: Climate change and infections – effects on clinical practice & sustainability

Resources

• Trainee Association of ESCIMD (TAE) 
• Doctors without Borders (Médecins sans Frontières), Antibiogo, https://www.antibiogo.org/
• Doctors without Borders (Médecins sans Frontières), Mini-lab, https://fondation.msf.fr/en/projects/mini-lab 

Further Reading

• Abbara A, et al. Unravelling the linkages between conflict and antimicrobial resistance. NPJ Antimicrob Resist. 2025. DOI: 10.1038/s44259-025-00099-y
• Abbara A, et al. A summary and appraisal of existing evidence of antimicrobial resistance in the Syrian conflict. Int J Infect Dis. 2018. DOI: 10.1016/j.ijid.2018.06.010
• Abu-Shomar R, et al. Multidrug-resistant Pseudomonas isolated from water at primary health care centers in Gaza, Palestine: a cross-sectional study. IJID Reg. 2025. DOI: 10.1016/j.ijregi.2025.100671
• Aldbis A, et al. The lived experience of patients with conflict associated injuries whose wounds are affected by antimicrobial resistant organisms: a qualitative study from northwest Syria. Confl Health. 2023. DOI: 10.1186/s13031-023-00501-4
• Aro T, et al. War on antimicrobial resistance: high carriage rates of multidrug-resistant bacteria among war-injured Ukrainian refugees. Clin Microbiol Infect. 2025. DOI: 10.1016/j.cmi.2025.07.010  
• Bazzi W, et al. Heavy Metal Toxicity in Armed Conflicts Potentiates AMR in A. baumannii by Selecting for Antibiotic and Heavy Metal Co-resistance Mechanisms. Front Microbiol. 2020. DOI: 10.3389/fmicb.2020.00068 
• Dewachi O. War Biology and Antimicrobial Resistance: The Case of Gaza, AMR Insights, 2024.
• Granata G, et al. The impact of armed conflict on the development and global spread of antibiotic resistance: a systematic review. Clin Microbiol Infect. 2024. DOI: 10.1016/j.cmi.2024.03.029 
• Huang XZ, et al. Molecular analysis of imipenem-resistant Acinetobacter baumannii isolated from US service members wounded in Iraq, 2003-2008. Epidemiol Infect. 2012. DOI: 10.1017/S0950268811002871
• Hujer KM, et al. Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center. Antimicrob Agents Chemother. 2006. DOI: 10.1128/AAC.00778-06
• Karah N, et al. Teleclinical Microbiology: An Innovative Approach to Providing Web-Enabled Diagnostic Laboratory Services in Syria. Am J Clin Pathol. 2022. DOI: 10.1093/ajcp/aqab160
• Keen EF 3rd, et al. Evaluation of potential environmental contamination sources for the presence of multidrug-resistant bacteria linked to wound infections in combat casualties. Infect Control Hosp Epidemiol. 2012. DOI: 10.1086/667382
• Murray CK, et al. Recovery of multidrug-resistant bacteria from combat personnel evacuated from Iraq and Afghanistan at a single military treatment facility. Mil Med. 2009. DOI: 10.7205/milmed-d-03-8008
• Petersen K, et al. Diversity and clinical impact of Acinetobacter baumannii colonization and infection at a military medical center. J Clin Microbiol. 2011. DOI: 10.1128/JCM.00766-10
• Scott P, et al. An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis. 2007. DOI: 10.1086/518170
• Sensenig RA, et al. Longitudinal characterization of Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus colonizing and infecting combat casualties. Am J Infect Control. 2012. DOI: 10.1016/j.ajic.2011.03.025
• World Health Organization. Fourth WHO Global Evidence Review on Health and Migration stresses that equitable access to and appropriate use of antibiotics for refugees and migrants is essential to tackling Antimicrobial Resistance, News, 2022.

Once confined to the tropics, dengue is spreading via its vector, the Aedes mosquito, to more temperate regions, causing increases in global morbidity, mortality and cost. In 2019, the WHO recognised dengue as one of the top ten global health threats alongside climate change and antimicrobial resistance [1]. In this episode of Communicable, Annie Joseph and Nav Narayanan welcome two dengue experts, André Siqueira of the non-profit Drugs for Neglected Diseases Initiative based in Geneva, Switzerland (Rio de Janeiro, Brazil), and Steven Lim of the Raja Permaisuri Bainun Hospital (Ipoh, Malaysia). Together, they discuss the epidemiology, clinical presentation and management of dengue including comparisons to other arboviral infections like zika and chikungunya, and the heightened risk of disease for vulnerable populations such as pregnant women and those with comorbidities. The conversation also highlights innovative vector-control strategies and candidate therapeutics currently under investigation. 

This episode was edited by Kathryn Hostettler and peer reviewed by Loora Grünvald of the University of Tartu, Estonia.

Resources:

• Drug for Neglected Diseases (DNDi), https://dndi.org/ 
• Dengue Alliance, https://dndi.org/global-networks/dengue-alliance/ 
• Qdenga vaccine information: https://travelhealthpro.org.uk/news/763/qdenga-dengue-vaccine-guidance
• Dengavaxia vaccine information: https://www.cdc.gov/dengue/hcp/vaccine/index.html 

References: 

1. World Health Organization, Ten threats to global health in 2019.

Further reading: 

• Treating a feverish planet: The Dengue Alliance, a video

In the first Communicable episode of 2026, Annie Joseph and Josh Nosanchuk invite Robin Patel (Rochester, USA) and Fidelma Fitzpatrick (Dublin, Ireland) to discuss some of their favourite clinical microbiology papers published in 2025. These six papers highlight everything from technological advances of genomics and molecular diagnostic testing to the importance of patient and public involvement in research as well as effective communication [1-6]. The panel also discusses whether or not any of these papers have changed their practice.

This episode was edited by Kathryn Hostettler and peer reviewed by Sinéad Kilgarriff of the National Virus Reference Laboratory University College, Dublin in Ireland. 

Robin’s papers

• Oyeniran SJ, et al. J Clin Microbiol 2025. DOI: https://doi.org/10.1128/jcm.00986-25 
• Xie O, et al. Lancet Microbe 2025. DOI: 10.1016/j.lanmic.2025.101182
• Lopopolo M et al., Science 2025. DOI: 10.1126/science.adu7144

Fidelma’s papers

• Turner NA, et al. JAMA 2025. DOI: 10.1001/jama.2025.12543  
• Paterson DL, et al. Lancet Infectious Diseases 2025. DOI: 10.1016/S1473-3099(25)00469-4
• Langford BJ, et al. Antimicrobial Stewardship & Healthcare Epidemiology 2025. DOI: 10.1017/ash.2025.10210

Related podcast episodes

• Communicable episode 1: Late breaker trials at ESCMID Global 2024, https://share.transistor.fm/s/9c598f68

References

1. Oyeniran SJ, et al. J Clin Microbiol 2025. DOI: https://doi.org/10.1128/jcm.00986-25 
2. Xie O, et al. Lancet Microbe 2025. DOI: 10.1016/j.lanmic.2025.101182
3. Turner NA, et al. JAMA 2025. DOI: 10.1001/jama.2025.12543  
4. Paterson DL, et al. Lancet Infectious Diseases 2025. DOI: 10.1016/S1473-3099(25)00469-4
5. Lopopolo M et al., Science 2025. DOI: 10.1126/science.adu7144
6. Langford BJ, et al. Antimicrobial Stewardship & Healthcare Epidemiology 2025. DOI: 10.1017/ash.2025.10210

Further reading

• Mohammed HT, et al. IJSEM 2025. DOI: 10.1099/ijsem.0.006986  
• Skally M, et al. BMJ Open 2025. DOI: 10.1136/bmjopen-2025-103431
• Ong SWX and Tverring J. CMI Communications 2025. DOI: 10.1016/j.cmicom.2025.105154
• Tverring J and Ong SWX. CMI Communications 2025. DOI: 10.1016/j.cmicom.2025.105169 

In this final episode of 2025, hosts Annie Joseph (Nottingham, UK) and Angela Huttner (Geneva, Switzerland), interview Communicable's producer, Katie Hostettler-Oi (Zurich, Switzerland), to learn which episodes she liked best this year. Their discussion provides a behind-the-scenes look at some of the episodes--including the strange surprises that sometimes came with them. Finally, the CMI Comms editors and editorial fellows send in their perspectives on 2025 and their wishes for 2026.

During the COVID-19 pandemic with lockdown mandates and social distancing, doctors, researchers, and the public were able to find refuge and community online; for the infectious disease community, it was on the social media platform Twitter, and more specifically under the widely used hashtag, #IDTwitter. Under new ownership from 2022, however, Twitter’s name and brand changed to what we now know as X, and “the heyday of #IDTwitter is long since gone”. In this special episode of Communicable, Angela Huttner and Marc Bonten invite doctors and science communicators, Neil Stone (London, UK), Ilan Schwartz (Durham, USA), and Tara Smith (Kent, USA) to debate whether we should stay on X or leave it for alternatives.

This episode is a follow-up from Stone and Schwartz’s commentary [1] and Smith’s response letter [2] addressing the same topic published in CMI Communications. The views expressed by the panelists are their own and do not represent the positions of their affiliated institutions or ESCMID. This episode was not peer reviewed.

Resources

You can follow all participants of this episode on Bluesky: @drneilstone.bsky.social, @germhuntermd.bsky.social, @aetiology.bsky.social, @marcbonten.bsky.social, @angelahuttner.bsky.social, and Stone on X: @DrNeilStone.

References

1. Stone NRH and Schwartz IS. Joining the X-odus: Contrasting perspectives on whether infection specialists should leave X (formerly Twitter). CMI Comms 2025. DOI: 10.1016/j.cmicom.2025.105140
2. Smith TC. Twitter remains a haven of harassment. CMI Comms 2025. DOI: 10.1016/j.cmicom.2025.105144

Further reading

• Biever, C. Bluesky’s science takeover: 70% of Nature poll respondents use platform. Nature News 2025. 
• PEW Research Center. How Do Americans View Childhood Vaccines, Vaccine Research and Policy? https://www.pewresearch.org/science/2025/11/18/how-do-americans-view-childhood-vaccines-vaccine-research-and-policy/   
• NBC News. X’s new location labels unmask users. Insiders say the idea was rejected for years. https://www.nbcnews.com/tech/elon-musk/x-user-location-feature-country-elon-musk-new-rcna245620

In the last ten years, 'diagnostic stewardship' has emerged as a core principle of good clinical practice whose implementation impacts both the individual patient and public health at large. In this episode of Communicable, hosts Angela Huttner and Annie Joseph invite two experts in the field, Daniel Morgan (Maryland, USA) and Valerie Vaughn (Utah, USA), to discuss diagnostic stewardship in the context of infectious diseases, hospital medicine, and healthcare in general. Other topics covered include practical interventions for better testing practices and the role of artificial intelligence in the future of diagnostics. The episode highlights how thoughtful, intentional diagnostic practices can enhance clinician workflows and improve patient outcomes.

This episode is a follow-up from Morgan’s recently published commentary in CMI Communications on diagnostic testing, and the need for evaluating its clinical impact [1]. The episode was peer reviewed by Özlem Türkmen Recen of Çınarcık State Hospital, Yalova, Türkiye. 

References

1. Baghdadi JD & Morgan DJ. Diagnostic tests should be assessed for clinical impact. CMI Comms 2024. DOI: 10.1016/j.cmicom.2024.105010

Further reading

• Advani S and Vaughn VM. Quality Improvement Interventions and Implementation Strategies for Urine Culture Stewardship in the Acute Care Setting: Advances and Challenges. Curr Infect Dis Rep 2021. DOI: 10.1007/s11908-021-00760-3 
• Core Elements of Hospital Antibiotic Stewardship Programs, https://www.cdc.gov/antibiotic-use/hcp/core-elements/hospital.html 
• Core Elements of Hospital Diagnostic Excellence (DxEx), https://www.cdc.gov/patient-safety/hcp/hospital-dx-excellence/index.html
• Cosgrove SE & Srinivasan A. Antibiotic Stewardship: A Decade of Progress. Infect Dis Clin North Am 2023. DOI: 10.1016/j.idc.2023.06.003 
• Dik JH, et al. Integrated Stewardship Model Comprising Antimicrobial, Infection Prevention, and Diagnostic Stewardship (AID Stewardship). J Clin Microbiol 2017. DOI: 10.1128/jcm.01283-17
• Fabre V, et al. Principles of diagnostic stewardship: A practical guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force. Infect Control Hosp Epidemiol 2023. DOI: 10.1017/ice.2023.5 
• Huttner A, et al. Re: ‘ESR and CRP: it's time to stop the zombie tests’ by Spellberg et al. CMI 2025. DOI: 10.1016/j.cmi.2024.09.016 
• Morgan DJ, et al. Diagnostic Stewardship—Leveraging the Laboratory to Improve Antimicrobial Use. JAMA 2017. DOI:  10.1001/jama.2017.8531 
• Messacar K, et al. Implementation of rapid molecular infectious disease diagnostics: the role of diagnostic and antimicrobial stewardship. J Clin Microbiol 2017. DOI: 10.1128/jcm.02264-16
• Messacar K, et al. Clinical and Financial Impact of a Diagnostic Stewardship Program for Children with Suspected Central Nervous System Infection. J Pediatr. 2022. DOI: 10.1016/j.jpeds.2022.02.002  
• Qian ET, et al. Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA 2023. DOI: 10.1001/jama.2023.20583 
• Siontis KC et al. Diagnostic tests often fail to lead to changes in patient outcomes. J Clin Epidemiol 2014. DOI: 10.1016/j.jclinepi.2013.12.008
• Vaughn VM, et al. Antibiotic Stewardship Strategies and Their Association With Antibiotic Overuse After Hospital Discharge. Clin Infect Dis 2022. DOI: 10.1093/cid/ciac104
• Vaughn VM, et al. A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria. JAMA Intern Med 2023. DOI: 10.1001/jamainternmed.2023.2749  

In this episode of Communicable, Josh Davis (Newcastle, Australia) and Emily McDonald (Montreal, Canada), plus invited guest, Steven Tong (Melbourne, Australia)—all practicing physicians and clinical trialists—assemble to discuss some of their ‘top infectious diseases papers published in 2025’. Bassam Ghanem (Jeddah, Saudi Arabia), whom one might know better as Antibiotic Steward on social media, was also invited to share his favourite publications of 2025.

Six papers that were most consistently picked by the panel are presented, explaining why they were picked and how they have shifted paradigms or changed their practice. This episode complements the previous episode, which presented ‘top clinical microbiology papers in 2025’, and was peer reviewed by Akshatha Ravindra of Kasturba Medical College, Manipal, India.  

Resources

• CLARITY initiative website

Papers presented (in order of presentation) 

1. Turner NA, et al. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia. JAMA
2. Meya DB, et al. Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis. NEJM
3. Vodstrcil LA, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. NEJM
4. Kreimer A, et al. Noninferiority of One HPV Vaccine Dose to Two Doses. NEJM
5. Guglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. NEJM
6. Ross JDC et al, Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1). Lancet  

‘One liners’ (in order of presentation)

1. Burdet C et al. Cloxacillin versus cefazolin for meticillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa). Lancet
2. Lemiale V et al, Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC). Lancet Respir Med
3. Luetkemeyer AF et al, Doxycycline to prevent bacterial sexually transmitted infections in the USA. Lancet Inf Dis
4. Eyting M, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature
5. Xie M, et al. The effect of shingles vaccination at different stages of the dementia disease course. Cell
6. Pomirchy M, et al. Herpes Zoster Vaccination and Dementia Occurrence. JAMA
7. Durbin AP et al, Daily Mosnodenvir as Dengue Prophylaxis in a Controlled Human Infection Model. NEJM
8. Hook EW et al, One Dose versus Three Doses of Benzathine Penicillin G in Early Syphilis. NEJM
9. Opdam MAA et al, Continuation versus temporary interruption of immunomodulatory agents during infections in patients with inflammatory rheumatic diseases. Clin Infect Dis
10. Arundel C et al, Negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention in the UK (SWHSI-2). Lancet

Honourable mentions

• Chaccour C, et al. Ivermectin to Control Malaria. NEJM
• Lucinde RK, et al. A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. NEJM
• Morel J, et al. Effect of a 1-month methotrexate delay on pneumococcal vaccine immunogenicity and disease control in patients with early rheumatoid arthritis (VACIMRA). Lancet Rheumatol
• Haukoos J, et al. Hepatitis C Screening in Emergency Departments. JAMA
• Major Extremity Trauma Research Consortium (METRC). Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial, JAMA Surg
• Anderson CS, et al. Influenza vaccination to improve outcomes for patients with acute heart failure (PANDA II). Lancet
• St Peter SD, et al. Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children. Lancet
• Pan CQ, et al. Tenofovir and Hepatitis B Virus Transmission During Pregnancy. JAMA
• Gohil SK, et al. Improving Empiric Antibiotic Selection for Patients Hospitalized With Abdominal Infection. JAMA Surg

Related podcast episodes

• Communicable E44: Top clinical microbiology papers in 2025 https://share.transistor.fm/s/6e5c26ae
• Communicable E29: Bacterial vaginosis & male partners, https://share.transistor.fm/s/3de4f5c3 
• Communicable E28: Late-breaker trials at ESCMID Global: Should they change your practice? - part 2, https://share.transistor.fm/s/4f044e8c 
• Communicable E20: Tuberculosis today https://share.transistor.fm/s/9858900e 

In this episode of Communicable, Navaneeth Narayanan and Josh Nosanchuk invite Virginie Lemiale and Elie Azoulay (Paris, France) as well as fellow editor Emily McDonald (Montreal, Canada)—this time as guest—to discuss adjunctive steroid therapy for pneumocystis pneumonia (PCP) in HIV-negative individuals. In 2025, Lemiale and Azoulay published results from their double-blind, randomised controlled trial investigating steroid treatment for severe Pneumocystis jirovecii pneumonia (PIC trial) in the Lancet Respiratory Medicine [1]. At first glance, one might dismiss the study’s clinical impact due the ‘negative' result of  the primary outcome, mortality at 28 days, which just missed a statistically significant difference between groups. There was a clinical difference, however, and all other outcomes, including 90-day mortality, were significantly different between groups. Understanding how pivotal these results were to clinical practice, McDonald and colleagues sought to contextualise the results of the PIC trial through a Bayesian analysis in a follow-up publication [2]. While the discussion provides useful clinical commentary, it also helps both to demystify Bayesian analysis and to call attention to what might be lost with strict or overly concrete interpretations of traditional frequentist analyses. 

This episode was peer reviewed by Arjana Zerja from the Mother Theresa University Hospital Center, Tirana, Albania.

References

1. Lemiale V, et al. Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC): a multicentre, double-blind, randomised controlled trial. Lancet Respir Med. 2025;13(9):800-808. doi:10.1016/S2213-2600(25)00125-0.
2. Lee TC, Albuquerque AM, McDonald EG. Contextualizing the use of corticosteroids in severe Pneumocystis jirovecii pneumonia through a Bayesian lens. CMI Commun. 2025;2(4):105141. doi:10.1016/j.cmicom.2025.105141.

Communicable is launching a new series on everything related to pharmacokinetics (PK) and pharmacodynamics (PD). Kicking off this series are hosts Thomas Tängdén, Erin McCreary and Angela Huttner, and invited guests Amy Legg and Rekha Pai Mangalore. They walk us through key parameters and terms of PK/PD, such as volume of distribution, minimum inhibitory concentration (MIC), epidemiological cut-off value (ECOFF), and PK/PD indices, laying the foundation to better comprehend clinical applications such as setting a clinical breakpoint and how it guides therapeutic drug monitoring (TDM). This first episode encompasses a broad scope across PK/PD theory, preparing the listener for subsequent episodes that will explore these topics with greater depth and make you love PK/PD. 

This episode was peer-reviewed by Ummu Afeera Zainulabid of the International Islamic University, Kuantan, Malaysia.   

Terms and definitions 

• ADME, a drug’s journey through the body: absorption, distribution, metabolism, excretion
• Volume of distribution, a parameter describing the theoretical volume that would be necessary to contain the total amount of an administered drug at the same concentration that it is observed in the blood plasma
• Clearance, the volume of blood cleared of drug per unit time
• Half-life, the time required for the concentration of a drug to decrease to half of its initial amount in the body
• Loading dose, a larger initial dose designed to rapidly bring drug levels into the therapeutic range
• Steady state, an equilibrial condition in which the rate of input of a drug is equal to the rate of its output
• MIC, minimum inhibitory concentration
• ECOFF, epidemiological cut-off value: the highest MIC value of isolates that are not known to have resistance and are therefore considered representative of wild-type bacterial isolates
• Clinical breakpoint setting, takes into account drug dosing, PK/PD, site of infection, clinical data; what we think is the breakpoint for the lab to call a bacterial organism susceptible to a drug
• PK/PD index, a parameter that describes the observed antimicrobial activity of an antimicrobial; there are three different indices: 
  1. T>MIC (bacterial killing depends on the drug concentration’s remaining higher than the MIC over time)
  2. Cmax/MIC (bacterial killing depends on the drug’s peak concentration)
  3. AUC/MIC (bacterial killing depends on the area under the curve over the MIC)
• TDM, therapeutic drug monitoring

Further reading

• Mouton JW, et al. MIC-based dose adjustment: facts and fables. J Antimicrob Chemother 2018. doi:10.1093/jac/dkx427
• Märtson A, et al. The pharmacokinetics of antibiotics in patients with obesity: a systematic review and consensus guidelines for dose adjustments. Lancet Infect Dis 2025. doi: 10.1016/S1473-3099(25)00155-0
• Eagle H and Musselman AD. The rate of bactericidal action of penicillin in vitro as a function of its concentration, and its paradoxically reduced activity at high concentrations against certain organisms. J Exp Med 1948. doi: 10.1084/jem.88.1.99

This is the first episode of the 'Quarterly catchup' series, in which CMI Communications editors discuss important and useful articles that have come out in the last 3 months to understand their results and potential clinical impact. In this inaugural episode of 'Quarterly catchup', Emily McDonald (Canada), Thomas Tängdén (Sweden) and Navaneeth Narayanan (USA) convene to discuss clinical microbiology and infectious diseases studies published in the first quarter of 2026 [1-6]. From Wolbachia-infected mosquitoes reducing dengue infection to exploration of antibiotic combination therapies against multidrug-resistant organisms, our hosts summarize six articles they found the most interesting, and discuss whether they can and should change clinical practice. 
 
This episode was peer reviewed by Connor Prosty of McGill University, Montréal, Canada.  

References

1. Lim JT, et al. Dengue suppression by Male Wolbachia-Infected mosquitoes. NEJM 2026. doi: https://doi.org/10.1056/NEJMoa2503304 
2. Escrihuela-Vida F, et al. Adjunctive Fosfomycin for the Treatment of Staphylococcus aureus Bacteremia: A Pooled Post Hoc Analysis of Individual Participant Data From 2 Randomized Trial. Clin Infect Dis 2026. doi: https://doi.org/10.1093/cid/ciaf387 
3. Baldanzi G, et al. Antibiotic use and gut microbiome composition links from individual-level prescription data of 14,979 individuals. Nat Med 2026. doi: https://doi.org/10.1038/s41591-026-04284-y.
4. Quentin Vallé, et al. Evaluating the antibacterial activity of ceftazidime/avibactam and aztreonam combinations against multidrug-resistant Stenotrophomonas maltophilia complex isolates in a hollow fibre infection model.  Clin Microbiol Infect 2026. doi: https://doi.org/10.1016/j.cmi.2026.02.010 
5. Rana AI, et al. Cabotegravir plus Rilpivirine for Persons with HIV and Adherence Challenges. NEJM 2026. doi: https://doi.org/10.1056/NEJMoa2508228 
6. Donovan J, et al. Genotype-stratified adjunctive dexamethasone for tuberculous meningitis in HIV-negative adults: a randomized controlled phase 3 trial. Nat Med 2026. doi: https://doi.org/10.1038/s41591-025-04138-z 

Further reading

• Thwaite GE, et al. Dexamethasone for the Treatment of Tuberculous Meningitis in Adolescents and Adults. NEJM 2004. doi: https://doi.org/10.1056/NEJMoa040573 
• Behrmann LV. “The specimen is never wrong”: the pathologist behind Wolbachia. CMI Communications, 2026. doi: https://doi.org/10.1016/j.cmicom.2026.105185                

In this episode of Communicable, hosts Angela Huttner and Marc Bonten invite two members of the ESCMID Emerging Infections Subcommittee, Martin Grobusch (Amsterdam, Netherlands) and Pikka Jokelainen (Copenhagen, Denmark), to discuss infectious disease outbreaks. Sparked by the Subcommittee's beloved 'Epi Alert', which identifies and tracks outbreaks around the world, the episode covers common missteps and underestimated challenges in handling new outbreaks, the effects of climate change, and what 'One Health' really means. 

This episode was peer reviewed by Ummu Afeera Zainulabid of the International Islamic University Malaysia, Kuantan, Malaysia.

Further reading

• Epi Alert. https://www.escmid.org/science-research/emerging-infections-subcommittee/eis-activities/
• Pellejero-Sagastizábal G, et al. Delayed correct diagnoses in emerging disease outbreaks: historical patterns and lessons for contemporary responses. CMI 2025. https://www.clinicalmicrobiologyandinfection.org/article/S1198-743X(25)00169-7/fulltext 
• One Health High-Level Expert Panel (OHHLEP), et al. One Health: A new definition for a sustainable and healthy future. PLoS Pathogens 2022. https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1010537 
• Swiss Tropical and Public Health Institute News. https://www.swisstph.ch/en/news

Yesterday was International Women's Day. In light of that, Communicable prepared a special episode in which hosts Erin McCreary and Annie Joseph are joined by Esmita Charani (South Africa) and Annette Westgeest (Netherlands) for a discussion on gender- and sex-dependent patient-care disparities in the infectious diseases space. Together they review recent research findings that identified gender and sex as important determinants influencing patient outcomes and even decision making by prescribers. They also explore how societal and cultural norms may introduce further nuance and complexities. The panel remains optimistic in reaching equal healthcare for all, reflecting also on progressive steps such as increasing recognition by international organisations like the WHO, which published guidance on gender inequalities in national plans on AMR in 2024.

This episode was peer reviewed by Casandra Bulescu at the Dr. Victor Babes Clinical Hospital of Infectious and Tropical Diseases in Bucharest, Romania.

References

• Charani E, et al. Wellcome Open Research, 2024. 
• Charani E, et al. Lancet Global Health, 2023.
• WHO guidance on gender inequalities in national action plans on AMR, 2024.
• Westgeest AC's presentation at ESCMID Global 2023.
• Dellière S, et al. Clin Microbiol Infect, 2026.
• Westgeest AC, et al. Clin Microbiol Infect, 2023.
• Madsen TE, et al. DISPARITY-II study, 2014.
• Criado Perez, C. Invisible Women. 
• Ausman SE, et al. CLASI study, 2023.
• Vaughn VM, et al. ICHE, 2022.
• Szymczak JE. Clin Infect Dis, 2019.