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:
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, severe and long-lasting adverse events, and substantial collateral effects on various 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 thus entails long treatment durations. They review the standard of care for PJIs, including FQs in combination with rifampacin vs other antibiotic combinations, the impact of the OVIVA trial advocating for early-oral-switch strategies, the long list of rare but severe side effects, and how best to preserve FQs for applications that most need it.
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
Further reading
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
Literature
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
Further reading
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
References
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:
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 Groom, 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:
SNAP Adaptive trial platform/results of the PSSA & MSSA domains:
CloCeBa trial results (ESCMID Global April 2025 presentation):
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
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.
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
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:
Literature
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:
Literature:
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/
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
Additional resources
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
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
