Communicable

In this episode of Communicable, hosts Emily McDonald and Marc Bonten are joined by Sylvain Lother and Valentijn Schweitzer for a discussion on the use of macrolides in community-acquired pneumonia. Together, they examine the evidence for adding a macrolide to beta-lactam therapy, which patients may benefit from combination treatment, and how available evidence can inform clinical practice.Resources: AMMI Canada, https://ammi.ca/en/home/Further readingPostma DF, et al. Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults (CAP-START). NEJM 2015. DOI: 10.1056/NEJMoa1406330 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 Schweitzer VA, et al. Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial. Lancet Infect Dis 2022. DOI: 10.1016/S1473-3099(21)00255-3van Daalen FV, et al. Management of community-acquired pneumonia in adults: Practice Guideline from The Dutch Working Party on Antibiotic Policy and Dutch Association of Chest Physicians. CMI Comms 2026. DOI: 10.1016/j.cmicom.2026.105206

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). ReferencesPaul, 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 readingHarris 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.

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, excretionVolume 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 plasmaClearance, the volume of blood cleared of drug per unit timeHalf-life, the time required for the concentration of a drug to decrease to half of its initial amount in the bodyLoading dose, a larger initial dose designed to rapidly bring drug levels into the therapeutic rangeSteady state, an equilibrial condition in which the rate of input of a drug is equal to the rate of its outputMIC, minimum inhibitory concentrationECOFF, 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 isolatesClinical 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 drugPK/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 monitoringFurther readingMouton JW, et al. MIC-based dose adjustment: facts and fables. J Antimicrob Chemother 2018. doi:10.1093/jac/dkx427Märtson 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)00155-0Eagle 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

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 readingEpi 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

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 InfectionsFurther readingESCMID 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

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. ResourcesCLARITY initiative websitePapers presented (in order of presentation) Turner NA, et al. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia. JAMAMeya DB, et al. Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis. NEJMVodstrcil LA, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. NEJMKreimer A, et al. Noninferiority of One HPV Vaccine Dose to Two Doses. NEJMGuglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. NEJMRoss 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). LancetLemiale V et al, Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC). Lancet Respir MedLuetkemeyer AF et al, Doxycycline to prevent bacterial sexually transmitted infections in the USA. Lancet Inf DisEyting M, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. NatureXie M, et al. The effect of shingles vaccination at different stages of the dementia disease course. CellPomirchy M, et al. Herpes Zoster Vaccination and Dementia Occurrence. JAMADurbin AP et al, Daily Mosnodenvir as Dengue Prophylaxis in a Controlled Human Infection Model. NEJMHook EW et al, One Dose versus Three Doses of Benzathine Penicillin G in Early Syphilis. NEJMOpdam MAA et al, Continuation versus temporary interruption of immunomodulatory agents during infections in patients with inflammatory rheumatic diseases. Clin Infect DisArundel C et al, Negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention in the UK (SWHSI-2). LancetHonourable mentionsChaccour C, et al. Ivermectin to Control Malaria. NEJMLucinde RK, et al. A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. NEJMMorel 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 RheumatolHaukoos J, et al. Hepatitis C Screening in Emergency Departments. JAMAMajor Extremity Trauma Research Consortium (METRC). Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial, JAMA SurgAnderson CS, et al. Influenza vaccination to improve outcomes for patients with acute heart failure (PANDA II). LancetSt Peter SD, et al. Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children. LancetPan CQ, et al. Tenofovir and Hepatitis B Virus Transmission During Pregnancy. JAMAGohil SK, et al. Improving Empiric Antibiotic Selection for Patients Hospitalized With Abdominal Infection. JAMA SurgRelated podcast episodesCommunicable E44: Top clinical microbiology papers in 2025 https://share.transistor.fm/s/6e5c26aeCommunicable 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 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.