Show Notes
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
More from Communicable
In this episode of Communicable, Emily McDonald returns for another ‘Quarterly catch-up’ and is joined by Angela Huttner as co-host. Together, they review four recent randomised clinical trials, focusing on antibiotic treatment duration and different treatment approaches across a range of infections and patient populations [1–4]. They discuss the results and weigh in on their implications for clinical practice. References Johnson, et al. Vancomycin Taper and Pulse or Fidaxomicin for Recurrent C. difficile Infection. NEJM Evid. DOI: 10.1056/EVIDoa2600016 Bundgaard, et al. Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis (POET II). NEJM. DOI: 10.1056/NEJMoa2607887 Bielicki, et al. Oral step-down, optimal drug, and total duration of antibiotic treatment in African children hospitalised with severe community-acquired pneumonia (PediCAP): a factorial randomised controlled trial. Lancet 2026. DOI: 10.1016/S0140-6736(26)00879-2 Carlsen, et al. Individualized Duration of Antibiotic Treatment in Culture-Negative Early-Onset Sepsis in Late Preterm and Term-Born Neonates in Denmark: A Multicenter, Open-Label, Randomised, Controlled Non-Inferiority Trial. Lancet Child Adolesc Health. DOI: 10.1016/S2352-4642(26)00118-5
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 reading Postma 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)00255-3 van 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
At the Critical Care Reviews meeting in Belfast in June this year, REMAP-CAP investigators presented results suggesting that oseltamivir may be harmful in critically ill patients with influenza, upending a long-standing clinical practice in intensive care [1]. In this fourth collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Josh Davis are joined by Steve Webb (Monash University), senior REMAP-CAP investigator and 'godfather of adaptive trial design', and Steve Tong (University of Melbourne), esteemed clinical trialist and friend of both podcasts. Together, they walk through the trial domain’s design, outcomes and results, also highlighting how these findings demonstrate the importance and clinical impact of randomised clinical trials. At the time of this episode recording in August, the results discussed were available as a preprint version [1]. Resources REMAP-CAP: A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia, https://www.remapcap.org/ References Murthy S, et al. Oseltamivir for Critically Ill Patients with Influenza: A Randomised Trial. Lancet 2026. Preprint http://dx.doi.org/10.2139/ssrn.7172531
In this episode of Communicable, Emily McDonald and Josh Davis host Henning Bundgaard and Sami El-Dalati for a discussion on early oral antibiotic switch for endocarditis, focusing on the POET trial, led by Bundgaard, and its clinical impact seven years after the results were first published in 2019 [1]. The episode also covers the ‘prose’ and cons of early oral switch therapy, as well as broader challenges of implementing new evidence in practice when it goes against long-standing dogma. References Iversen K, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis, NEJM 2018. DOI: 10.1056/NEJMoa1808312 Further reading: Pries-Heje MM, et al. Five-Year Outcomes of the Partial Oral Treatment of Endocarditis (POET) Trial, NEJM 2022. DOI: 10.1056/NEJMc2114046 El-Dalati S, et al. Partial Oral Versus Intravenous Antibiotic Therapy for Endocarditis With Management by a Multidisciplinary Team: A Retrospective Cohort Study, OFID 2025. DOI: 10.1093/ofid/ofaf625 McDonald EM, et al. Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement, JAMA Netw Open 2023. DOI: 10.1001/jamanetworkopen.2023.26366 European Society of Cardiology (ESC). 2023 ESC Guidelines for the management of endocarditis, 2023.
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