Communicable

Communicable E61: We will make you love PK/PD, part 3

In this episode of Communicable, Amy Legg (Brisbane, Australia), Rekha Pai Mangalore (Melbourne, Australia) & Angela Huttner (Geneva, Switzerland) return for the third part of the ‘We will make you love PK/PD’ series. The hosts are joined by two experts, Amanda Gwee (Melbourne, Australia) & Sebastian Wicha (Hamburg, Germany), to dive into an important application of PK/PD: model-informed precision dosing (MIPD), and how it allows for more informed, individualised dosing decisions. The episode also covers the open-access educational tools, KidsCalc and TDMx, developed by Gwee and Wicha respectively, and the steps clinicians can take to put MIPD into practice, keeping the individual patient at the centre of dosing decisions. Resources TDMx, https://www.tdmx.eu/ KidsCalc, https://www.kidscalc.org/ Further reading Broeker A, et al. Towards precision dosing of vancomycin: a systematic evaluation of pharmacometric models for Bayesian forecasting. CMI 2019. DOI: 10.1016/j.cmi.2019.02.029 Brusamarello C, et al. How important are MIC determination methods when targeting vancomycin levels in patients with Staphylococcus aureus infections? J Antimicrob Chemother 2021. DOI: 10.1093/jac/dkab065 De Cock PA, et al. Bedside model-informed precision dosing of vancomycin in severely ill neonates and children in Belgium (the BENEFICIAL trial): a multicentre, randomised controlled trial. Lancet Child Adolesc Health 2026. DOI: 10.1016/S2352-4642(25)00385-2 Gwee A, et al. Identifying a therapeutic target for vancomycin against staphylococci in young infants. J Antimicrob Chemother 2022. DOI: 10.1093/jac/dkab469 Haiping X, et al. Model-informed precision dosing of vancomycin in children 3 months to 18 years of age using Australia-wide data. Antimicrob Agents Chemother 2026. DOI: 10.1128/aac.01840-25 Harwood K, et al. Refining Absolute GFR Estimation in Children: Development and Validation of the GROW-GFR Equation. Front Pharmacol 2026. Minichmayr IK, et al. Model-informed precision dosing: State of the art and future perspectives. Adv Drug Deliv Rev 2024. DOI: 10.1016/j.addr.2024.115421 Starp J, et al. Towards model-informed precision dosing of intravenous linezolid: a multicentre external evaluation of pharmacokinetic models in critically ill adults. CMI 2026. DOI: 10.1016/j.cmi.2025.08.032 Wilkins AL, et al. Individualized vancomycin dosing in infants: prospective evaluation of an online dose calculator. Int J Antimicrob Agents 2023. DOI: 10.1016/j.ijantimicag.2023.106728 US National Kidney Foundation for different equations for kidney function estimates as related to drug dosing – estimating kidney function for medication related decisions: Frequently Asked Questions | National Kidney Foundation

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Communicable E60: Quarterly catch-up (August 2026 edition)

In the second edition of 'Quarterly catch-up', CMI Communications editors Emily McDonald and Erin McCreary round-up the biggest news in infectious diseases and review clinical microbiology and infectious diseases studies published in the second quarter of 2026 [1-4]. From Pneumocystis jirovecii pneumonia in solid-organ-transplant recipients to a double-blind randomised controlled trial reporting a new antibiotic for complicated urinary tract infections, Erin and Emily highlight four articles they found particularly noteworthy, and comment on whether the results can and should change clinical practice. References Alanio A, et al. Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a prospective observational cohort study, J Infect 2026. DOI: 10.1016/j.jinf.2026.106794 Ramendra R, et al. Procalcitonin to guide 7 versus 14 days of antibiotics in bloodstream infections: a secondary analysis of the BALANCE trial, JAMA Netw Open 2026. DOI: 10.1001/jamanetworkopen.2026.20973 Pai MP, et al. Challenging weight-tiered antibiotic prophylaxis in obese patients undergoing colorectal surgery using CT-derived body composition, CID 2026. DOI: 10.1093/cid/ciag383 Takahashi S, et al. Efficacy and safety of cefepime–nacubactam and aztreonam–nacubactam compared with imipenem–cilastatin for complicated urinary tract infection or acute uncomplicated pyelonephritis (Integral-1): a double-blind, randomised phase 3 trial. Lancet 2026. DOI: 10.1016/S0140-6736(26)00596-9 Further reading The SNAP Trial Group. Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia. NEJM 2026. DOI: 10.1056/NEJMoa2506905 The SNAP Trial Group. Benzylpenicillin versus flucloxacillin or cloxacillin for the treatment of penicillin-susceptible Staphylococcus aureus bacteraemia (SNAP): an international, multicentre, open-label, non-inferiority randomised controlled trial. Lancet 2026. DOI: 10.1016/S0140-6736(26)00761-0 McCreary EK, et al. Communicable episode 26: SNAP out of it – rethinking anti-staphylococcal penicillins for S. aureus bacteremia, the SNAP trial PSSA/MSSA results. Communicable Podcast 2025. https://share.transistor.fm/s/2a3c3bb4 Ilges D, et al. Anticalcitonin: limited utility of a context-dependent biomarker demonstrated in another real-world data set, CID 2026. DOI: https://doi.org/10.1093/cid/ciag396 Spellberg B. Procalcitonin–An enigmatic anxiolytic biomarker, JAMA Netw Open 2026. DOI: 10.1001/jamanetworkopen.2026.20978

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Communicable E59: 'Ask me anything' – EUCAST and CLSI leadership explain

In this episode of Communicable, Nav Narayanan and Thomas Tängdén kick off the first 'Ask me anything' episode, inviting EUCAST and CLSI leadership Sören Gatermann, Christian Giske and Amy Mathers to answer questions from our listeners. Together, they discuss the roles and operations of both organisations, similarities and differences between EUCAST and CLSI, how breakpoints and guidance documents are developed, set the record straight about the 'I' category, explain which data inform breakpoint decisions, and much more. This episode was edited by Communicable's executive producer, Angela Huttner. Further reading Documents/resources: CLSI MicroFree, https://em100.edaptivedocs.net/Login.aspx?ru=1 EUCAST: When there are no antifungal breakpoints EUCAST: When there are no breakpoints? Use_of_fosfomycin_iv_breakpoints_General_advice_20240528.pdf EUCAST: Definition of S, I and R EUCAST Guidance Document, “When there are no breakpoints”, https://www.eucast.org/bacteria/guidance-documents/ EUCAST Guidance Document for “Rare Yeasts”, https://www.eucast.org/fungi-afst/guidance-documents/ Articles (alphabetical): Bixby ML, et al. Fosfomycin Disk Diffusion Testing among Klebsiella pneumoniae Results in Frequent Inner Colonies and Categorical Disagreement Based on Conflicting Breakpoint Organization Recommendations. Microbiol Spectr 2023. DOI: 10.1128/spectrum.03363-22 DeMarco MG, et al. Impact of media brand on cefiderocol disk diffusion results. J Clin Microbiol 2025. DOI: 10.1128/jcm.01648-24 Giske CG, et al. Aminoglycoside breakpoints-the EUCAST approach and what this means for the clinician. CMI 2025. DOI: 10.1016/j.cmi.2025.08.015 Mouton JW, et al. MIC-based dose adjustment: facts and fables. J Antimicrob Chemother 2018. DOI: 10.1093/jac/dkx427 Narayanan N, et al. Amoxicillin-Clavulanate Breakpoints Against Enterobacterales: Rationale for Revision by the CLSI. Clin Infect Dis 2024. DOI: 10.1093/cid/ciae201 Narayanan N, et al. Amoxicillin-Clavulanate Breakpoints Against Enterobacterales: Rationale for Revision by the Clinical and Laboratory Standards Institute. Clin Infect Dis 2024. DOI: Pham Thanh D, et al. A novel ciprofloxacin-resistant subclade of H58 Salmonella Typhi is associated with fluoroquinolone treatment failure. eLife 2016. DOI: 10.7554/eLife.14003.001 Smekal A. Swedish multicentre study of target attainments with β-lactams in the ICU: which MIC parameter should be used? J Antimicrob Chemother 2023. DOI: 10.1093/jac/dkad327 Turnidge J, et al. How to: the application and analysis of categorical agreement in antimicrobial susceptibility testing using EUCAST breakpoints. CMI 2026. DOI: 10.1016/j.cmi.2025.12.018 Turnidge J, et al. Rationale for contemporary antimicrobial treatment of Stenotrophomonas maltophilia: a narrative review. CMI Comms 2025. DOI: 10.1016/j.cmicom.2025.105082 Weinstein M, et al. The CLSI Subcommittee on Antimicrobial Susceptibility Testing: Background, Organization, Functions, and Processes. J Clin Microbiol 2020. DOI: 10.1128/jcm.01864-19

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Communicable E58: Reducing hospital-acquired pneumonia – the HAPPEN trial and how it happened

In this episode of Communicable, Angela Huttner and Josh Davis are joined by Brett Mitchell, Aline Wolfensberger and Lauren Clack to discuss the HAPPEN trial to prevent hospital-acquired pneumonia led by Mitchell--and the important studies leading up to it [1-3]. The episode also explores trial designs used in their research that are both creative and practical, such as stepped-wedge and implementation trials, and how these approaches can bridge the gap between research and real-world practice. References Mitchell B, “The hospital acquired pneumonia prevention (HAPPEN) study: a multi-centre randomised controlled trial” in ESCMID Global 2026. https://online.escmid.org/media-6348-hospital-and-ventilator-associated-pneumonia-new-insights-on-prevention-diagnosis-and-treatment (Presentation). White NM, et al. Effectiveness of oral care for the prevention of non-ventilator hospital-acquired pneumonia (HAPPEN): a multicentre, stepped-wedge, cluster-randomised trial in Australia. Lancet Infect Dis 2026. DOI: 10.1016/S1473-3099(26)00235-5. Wolfensberger A, et al. Prevention of non-ventilator-associated hospital-acquired pneumonia in Switzerland: a type 2 hybrid effectiveness–implementation trial. Lancet Infect Dis 2023. DOI: 10.1016/S1473-3099(22)00812-X. Further reading HAPPEN study website: Study overview and resources www.happenstudy.com Cassini A, et al. Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study. PLoS Med 2016. DOI: 10.1371/journal.pmed.1002150. Pronovost P, et al. An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU. NEJM. DOI: 10.1056/NEJMoa061115. Bion J, et al. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Quality & Safety 2013. DOI: 10.1136/bmjqs-2012-001325. Dixon-Woods M, et al. Explaining Matching Michigan: an ethnographic study of a patient safety program. Implementation Sci 2013. DOI: 10.1186/1748-5908-8-70. Clack L, et al. Hybrid effectiveness-implementation studies in infection prevention and infectious diseases: a narrative review. CMI 2025. DOI: 10.1016/j.cmi.2025.10.022. Hospital Acquired Pneumonia Prevention (HAPPEN) Study: Statistical Analysis Plan https://www.medrxiv.org/content/10.1101/2025.08.14.25333719v1 Oral care practices and hospital-acquired pneumonia prevention: A national survey of Australian nurses https://pubmed.ncbi.nlm.nih.gov/38724299/ Nurses' experiences of providing oral care to hospitalised patients: A qualitative study https://pubmed.ncbi.nlm.nih.gov/40450434/

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Communicable E57: We will make you love PK/PD, part 2

In this episode of Communicable, Thomas Tängdén and Rekha Pai Mangalore return for part 2 of the ‘We will make you love PK/PD’ series. In this round, they are joined by Iris Minichmayr (Austria) and Phil Selby (Australia) for a deep dive into how PK/PD data and principles can be used as integral clinical tools to support dosing decisions. They break down technical concepts of pharmacometrics such as population PK models, Monte Carlo simulations, probability of target attainment (PTA), and cumulative fraction of response (CFR), helping to make these approaches more accessible to everyday clinical practice. This episode was edited by Kathryn Hostettler. The executive producer of Communicable is Angela Huttner. Further reading Tängdén T, et al. Personalised patient management and infection prevention: current evidence and future perspectives. In: ESCMID Global 2025. Available on ESCMID Media: https://media.escmid.org/videos/01K7HWCJAHZ464H3XXK97SZ842

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Communicable E56: Frequentist vs Bayesian for clinical trial analysis – 99% probability you’ll want to listen to this

In this episode of Communicable, Emily McDonald and Josh Davis are joined by Roger Lewis (USA) and Ian Marschner (Australia) to compare and contrast Bayesian and frequentist statistical approaches. The panel discusses the fundamental principles of both methods, common misconceptions, and the extent to which they are often more similar than many realise. Together, they explore their use in clinical trial design, analysis, and reporting, including adaptive trials and sequential learning. Additional topics include sample size misconceptions, regulatory versus clinical thresholds, and the challenges of interpreting post hoc reanalyses of negative trials. This episode was edited by Kathryn Hostettler and the executive producer of Communicable is Angela Huttner. Further reading: Berry SM, et al. Bayesian Adaptive Methods for Clinical Trials (Chapman & Hall/CRC Biostatistics Series). Boca Raton (FL): CRC Press; 2010. FDA Guidance Document: Use of Bayesian Methodology in Clinical Trials of Drug and Biological Products FDA, 2026, https://www.fda.gov/regulatory-information/search-fda-guidance-documents/use-bayesian-methodology-clinical-trials-drug-and-biological-products Lee TC, et al. Contextualizing the use of corticosteroids in severe Pneumocystis jirovecii pneumonia through a Bayesian lens. CMI Comms 2025, https://www.cmi-comms.org/article/S2950-5909(25)00082-4/fulltext Livingston EH and Lewis RJ. JAMA Guide to Statistics and Methods, https://jamaevidence.mhmedical.com/Book.aspx?bookId=2742 Marschner I. Confidence distributions for treatment effects in clinical trials: Posteriors without priors. Stat Med 2024, doi: 10.1002/sim.10000. Whitehead J. The design and analysis of sequential clinical trials. Revised 2nd ed. Chichester: John Wiley & Sons; 1997.

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Communicable E55: Bonus episode – Bundibugyo ebolavirus outbreak

In this bonus episode of Communicable, hosts Anne-Grete Märtson and Angela Huttner invite Martin Grobusch (University of Amsterdam; ESCMID Emerging Infections Subcommittee) and Daniel Bausch (National University of Singapore, London School of Hygiene & Tropical Medicine, and Geneva Graduate Institute) to discuss the Bundibugyo ebolavirus outbreak currently ongoing in the Democratic Republic of Congo and Uganda. Clinical and virological differences between Bundibugyo and Zaire ebolaviruses are discussed, as are the particular challenges for diagnosis, treatment, and prevention confronting healthcare workers of this outbreak. The episode accompanies two new publications in CMI Communications and CMI: Gupta N, Mora-Rillo M, Gkrania-Klotsas E, et al. Bundibugyo ebolavirus (BDBV): what first responders/clinicians need to know. CMI Communications, 2026; 2 (DOI: 10.1016/j.cmicom.2026.105207) Gupta N, Marta Mora-Rillo, Gkrania-Klotsas E, et al. Bundibugyo ebolavirus outbreak in the Democratic Republic of the Congo and Uganda: rapid assessment from the ESCMID Emerging Infections Subcommittee. Clin Microbiol Infect, 2026 (DOI: 10.1016/j.cmi.2026.05.042)

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Communicable E54: ESCMID Global Late Breakers, part 2

Our editors – Marc Bonten, Erin McCreary, Anne-Grete Märtson, Angela Huttner, and Josh Davis – are back for part two of the ESCMID Global Late Breakers series, summarising five more late-breaking trials presented at ESCMID Global 2026. They discuss the trials' strengths and weaknesses, and whether their results should change practice. The five trials presented in this half of the series are listed below, and links to their respective sessions can be watched and rewatched on the ESCMID Global Virtual Platform. Links to corresponding abstracts and publications where available are provided as well. Conflict of interest/involvement in the trials: Marc Bonten was the chair of the E.mbrace trial's steering committee Josh Davis is global co-lead of the SNAP trial Josh Davis was a site investigator on the E.mbrace trial Angela Huttner was an independent/unpaid member of the E.mbrace trial's steering committee and an investigator on the precursor phase 1 trial testing the E. coli vaccine PROCALBAN trial (Late-breaking clinical trials in sepsis management) Chowdhury F, et al. Use of Procalcitonin Point-Of-Care Testing to Guide De-Escalation of Antibiotic Therapy in Adult Sepsis Patients in a Tertiary Hospital in Bangladesh: A Randomised Controlled Open-Label Trial, Preprints with The Lancet, doi: 10.2139/ssrn.6541698 BENEFICIAL trial (Late-breaking clinical trials in sepsis management) De Cock PA, et al. Bedside model-informed precision dosing of vancomycin in severely ill neonates and children in Belgium (the BENEFICIAL trial): a multicentre, randomised controlled trial. Lancet Child Adolesc Health, doi: 10.1016/S2352-4642(25)00385-2 SNAP trial (Late-breaking clinical trials in sepsis management) Bowen A. Adjunctive clindamycin for treatment of Staphylococcus aureus bacteraemia: a randomised controlled trial within the S. aureus Network Adaptive Platform (SNAP), abstract Adjunctive betamethasone treatment of hypoxemic adults hospitalised with Mycoplasma pneumoniae community-acquired pneumonia: an open-label, multicentre, randomised, controlled trial (Late-breaking research from The Lancet) Hagman K, et al. Adjunctive betamethasone treatment of hypoxaemic adults hospitalised with Mycoplasma pneumoniae community-acquired pneumonia: an open-label, multicentre, randomised, controlled trial. Lancet 2026, doi: 10.1016/j.lanepe.2026.101610 E.mbrace trial (Vaccines: landmark trials and preventive immunisation) Cohen CA, et al. Randomised phase III trial of a 9-valent vaccine (ExPEC9V) for prevention of invasive Escherichia coli disease (IED) in older adults (E.mbrace), abstract The Swiss multicentre phase 1, first-in-human trial testing the conjugate E. coli vaccine: Huttner A et al. Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. Lancet Infect Dis 2017: May;17(5):528-537

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Communicable E53: ESCMID Global Late Breakers, part 1

The ESCMID Global Late Breakers series returns to Communicable! Five CMI Communications editors – Marc Bonten, Josh Davis, Angela Huttner, Anne-Grete Märtson, and Erin McCreary – handpicked five late-breaking trials presented at ESCMID Global 2026 to summarise their findings and discuss whether the results will change their practice. This is part one of the two-part series. Trials presented are listed below and links to their respective sessions can be watched and rewatched on the ESCMID Global Virtual Platform. Links to corresponding publications, if available, and mentioned related articles are provided as well. The FAST trial (Late-breaking research from JAMA) Banerjee R, et al. Fast Antimicrobial Susceptibility Testing for Gram-Negative Bacteremia. The FAST Randomized Clinical Trial, doi: 10.1001/jama.2026.5487 Srinivasan A. A Multinational Trial of Rapid Antimicrobial Susceptibility Testing. Is FASTer Better?, doi: 10.1001/jama.2026.5504 The CEFMEC trial (Poster session) Hayakawa K, et al. Effectiveness of cefmetazole versus meropenem for invasive urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli, Antimicrob Agents Chemother 2023, doi: 10.1128/aac.00510-23 The COBRA trial (Late-breaking trials in surgical infection prevention) Overdevest AG, et al. Antibiotic treatment for 1 day versus 4-7 days in patients with acute cholangitis after adequate endoscopic biliary drainage (COBRA): study protocol for a randomized controlled trial. Trials, doi: 10.1186/s13063-026-09524-7 The DOTS trial, a secondary analysis (Late-breaking research from JAMA) Lodise, TP, et al. Pharmacokinetics of Dalbavancin in Complicated Staphylococcus aureus Bacteremia: A Secondary Analysis of the DOTS Randomized Clinical Trial, JAMA 2026, doi: 10.1001/jamanetworkopen.2026.11652 Walls G, et al. Patient-reported Perceptions, Experiences, and Preferences Around Intravenous and Oral Antibiotics for the Treatment of Staphylococcus aureus Bacteremia: A Descriptive Qualitative Study, Clin Infect Dis 2026, doi: 10.1093/cid/ciaf522 Turner NA , et al. Dalbavancin for treatment of Staphylococcus aureus bacteremia: the DOTS randomized clinical trial. JAMA 2025, doi: 10.1001/jama.2025.12543 Maribavir for clinically significant cytomegalovirus infection in hematopoietic cell transplantation: a real-world retrospective international study of the Infectious Disease Working Party of EBMT (Late-breaking research from The Lancet) Paviglianiti A, et al. Maribavir for clinically significant cytomegalovirus infection in haematopoietic cell transplant recipients in Europe: a real-world multicentre retrospective registry study. Lancet 2026. doi: 10.1016/S1473-3099(26)00144-1

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Communicable E52: ESCMID Global Trials, PETER PEN and ASTARTE

In this collaborative episode of Breakpoints and Communicable, the hosts revisit the “trial run” session from ESCMID Global, a format designed to facilitate critical discussion of major infectious diseases trials. This episode focuses on two studies addressing bloodstream infections caused by third‑generation cephalosporin-resistant Enterobacterales [1]. Mical Paul (Rambam Health Care Campus, Israel) joins the podcast to discuss the PETER PEN trial [1,2], comparing piperacillin/tazobactam with meropenem, including its design, interim analyses, and interpretation alongside prior data such as MERINO. The episode also features Jesús Rodríguez‑Baño (University of Seville, Spain), who presents a post hoc analysis of the ASTARTE trial [1,3], comparing temocillin and carbapenems. This episode was edited by Lacy Worden and was peer reviewed by Jeanette Bouchard (Duke Antimicrobial Stewardship Outreach Network (DASON) Durham, NC, USA). References Paul, M., & Rodríguez-Baño, J. (2026, April 20). The trial run: treatment of ESBL bacteraemia - off to never-never land. [Presentation]. ESCMID Global 2026, Munich, Germany. ESCMID Global Virtual Platform. Bitterman R, Koppel F, Mussini C, et al. Piperacillin-tazobactam versus meropenem for treatment of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae: a study protocol for a non-inferiority open-label randomised controlled trial (PeterPen). BMJ Open. 2021;11(2):e040210. Published 2021 Feb 8. doi: 10.1136/bmjopen-2020-040210 Marín-Candón A, Rosso-Fernández CM, Bustos de Godoy N, et al. Temocillin versus meropenem for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistant Enterobacterales (ASTARTÉ): protocol for a randomised, pragmatic trial [Internet]. BMJ Open. 2021 Sep 27;11(9):e049481. doi: 10.1136/bmjopen-2021-049481 Further reading Harris PNA, et al. Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance: A Randomized Clinical Trial. JAMA. 2018;320(10):984–994. doi: 10.1001/jama.2018.12163.

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A message to listeners, 4 May 2026

This is a short message to Communicable listeners to inform them that the next episode will be released on Friday, 8 May, as it is a collaboration episode with Breakpoints, the podcast of the Society of Infectious Diseases Pharmacists. It will cover the two trials presented in Munich during ESCMID Global's late-breaker Trial Run session.

Communicable E51: We will make you love PK/PD, part 1

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: T>MIC (bacterial killing depends on the drug concentration’s remaining higher than the MIC over time) Cmax/MIC (bacterial killing depends on the drug’s peak concentration) 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

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Communicable E50: Quarterly catch-up (April 2026 edition)

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 Lim JT, et al. Dengue suppression by Male Wolbachia-Infected mosquitoes. NEJM 2026. doi: https://doi.org/10.1056/NEJMoa2503304 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 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. 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 Rana AI, et al. Cabotegravir plus Rilpivirine for Persons with HIV and Adherence Challenges. NEJM 2026. doi: https://doi.org/10.1056/NEJMoa2508228 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

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Communicable E49: Outbreaks & how to handle them

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

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Communicable E48: International Women's Day - are infections & AMR really different in women?

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.

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Communicable E47: Drawing the line - the writing, reach, and limits of guidelines

In this third collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Angela Huttner invite two veteran authors of guidelines and guidances, Pranita Tamma (Philadelphia, USA) and Benedikt Huttner (WHO, Geneva, Switzerland) [1-3]. Together, they deconstruct the complex landscape of developing and implementing guidelines into digestible components: they discuss why different organizations develop guidelines and what need they hope to fulfil, the framework including the GRADE methodology under which guidelines are written, and major barriers in the uptake of guidelines. The conversation also details the distinction between guideline and guidance as well as the art and science behind formulating recommendations or suggestions, with a few anecdotal cases sprinkled in from the panel. This episode was edited by Kathryn Hostettler and Lacy Worden. It was peer reviewed for Breakpoints by Lacy Worden and for Communicable by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. References WHO handbook for guideline development, 2nd Edition The WHO AWaRe (Access, Watch, Reserve) antibiotic book IDSA 2024 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections Further reading ESCMID AMR Guidelines, https://clinicalmicrobiologyandinfection.com/retrieve/pii/S1198743X21006790 GRADE working group, https://www.gradeworkinggroup.org/ GRADE Book, https://book.gradepro.org/ IDSA's intraabdominal guidelines, https://www.idsociety.org/practice-guideline/intra-abdominal-infections/ ESCMID Manual for Clinical Practice Guidelines and Other Guidance Documents, https://www.escmid.org/guidelines-journals/guidelines/ International Consensus Guidelines for the Optimal Use of the Polymyxins https://accpjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/phar.2209 American Thoracic Society guidelines on community-acquired pneumonia, https://www.atsjournals.org/doi/abs/10.1164/rccm.202507-1692ST

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Communicable E46: Steroids for pneumocystis pneumonia

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 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. 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.

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Communicable E45: Top infectious diseases papers in 2025

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) Turner NA, et al. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia. JAMA Meya DB, et al. Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis. NEJM Vodstrcil LA, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. NEJM Kreimer A, et al. Noninferiority of One HPV Vaccine Dose to Two Doses. NEJM Guglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. NEJM Ross JDC et al, Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1). Lancet ‘One liners’ (in order of presentation) Burdet C et al. Cloxacillin versus cefazolin for meticillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa). Lancet Lemiale V et al, Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC). Lancet Respir Med Luetkemeyer AF et al, Doxycycline to prevent bacterial sexually transmitted infections in the USA. Lancet Inf Dis Eyting M, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature Xie M, et al. The effect of shingles vaccination at different stages of the dementia disease course. Cell Pomirchy M, et al. Herpes Zoster Vaccination and Dementia Occurrence. JAMA Durbin AP et al, Daily Mosnodenvir as Dengue Prophylaxis in a Controlled Human Infection Model. NEJM Hook EW et al, One Dose versus Three Doses of Benzathine Penicillin G in Early Syphilis. NEJM Opdam MAA et al, Continuation versus temporary interruption of immunomodulatory agents during infections in patients with inflammatory rheumatic diseases. Clin Infect Dis 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

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Communicable E44: Top clinical microbiology papers in 2025

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 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 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 Lopopolo M et al., Science 2025. DOI: 10.1126/science.adu7144 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

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Communicable E43: Katie's picks

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.

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