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

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

1. 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.
2. 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 
3. 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.

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

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

Terms and definitions 

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

Further reading

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

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

References

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

Further reading

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

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

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

Further reading

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

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

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

References

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

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

1.  WHO handbook for guideline development, 2nd Edition
2.  The WHO AWaRe (Access, Watch, Reserve) antibiotic book
3.  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 

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

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

References

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

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

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

Resources

• CLARITY initiative website

Papers presented (in order of presentation) 

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

‘One liners’ (in order of presentation)

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

Honourable mentions

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

Related podcast episodes

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