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  

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 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

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 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

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

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