CMI Communications

CMI Communications is ESCMID’s first official fully open-access journal. It creates an interdisciplinary forum for knowledge exchange on translational and clinical aspects of infectious diseases and their prevention and control, microbiology, and related immunology, epidemiology, and public health. Readers can expect to find reviews and original articles providing knowledge and evidence to continually improve their healthcare practice, research, and policies.

Episode 14 - Substandard and falsified antimicrobials: what is their effect on patients and on AMR?

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 Commun14, 6153 (2023). doi: 10.1038/s41467-023-41542-w

WHO Global Surveillance and Monitoring System for substandard and falsified medical products (2017). WHO global surveillance and monitoring system for substandard and falsified medical products 

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Mission

The new journal will publish articles that are of practical use to infectious disease clinicians and clinical microbiologists — and thus to their patients. CMI Communications particularly wants to help early-career professionals broaden their skills, knowledge, and career opportunities. To do so, first submissions will have almost no formatting requirements and turnaround times will be short. CMI Com will host a regular podcast, and its website will include interactive features allowing debate, knowledge transfer, and other exchanges. The new journal should be thought of as a living platform — a sort of workbench, an endoplasmic reticulum where many little ribosomes can get together to build good things — and not as a bundle of papers arriving once a month in the mail.

“The new journal will publish articles that are of practical use to infectious disease clinicians and clinical microbiologists—and thus to patients.”

Angela Huttner

Editor-in-Chief
Go to CMI Communications

Open call for editors

There is now an open call to join the CMI Communications editorial team: editor in fungal infections and antifungal therapy

You can read the full details of what to expect and why you should join the CMI Communications editorial team in the open call sheet below. Don't miss this great opportunity and be sure to apply before the deadline on 15 January 2025.

Read more and apply


Open call for papers

The current open call for papers is outlined below. 

  • “In Other Words” (personal narratives by members of the ID/CM community) 
  • Re-emerging pathogens in the context of global warming: diagnostics, treatment and prevention 
  • Strategies and evidence for antimicrobial stewardship

More on technical guidance

Past podcasts episodes

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 Commun14, 6153 (2023). doi: 10.1038/s41467-023-41542-w

WHO Global Surveillance and Monitoring System for substandard and falsified medical products (2017). WHO global surveillance and monitoring system for substandard and falsified medical products 

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The market of predatory publishing is as lucrative as it is unethical. Predatory journals are disguised as legitimate entities, and prey on both early-career academics and the naïve. In this episode, hosts Angela Huttner and Marc Bonten are joined by Editors-in-chief Ursula Hofer (Lancet Infect Dis) and Leonard Leibovici (CMI) to discuss the various schemes of the ‘Wild West’ of publishing, and how to avoid them. 

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Özlem Türkmen Recen, Izmir Public Health Laboratory, Izmir, Türkiye. 

Literature 

Research4Life  
Benedictus R et al. Nature 2016. doi: 10.1038/538453a

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Enterococci are commensal microbes, part of the healthy microflora populating the human gut. But they are also opportunistic pathogens and notorious nosocomial agents with intrinsic traits that promote their pathogenesis and make them difficult to kill. In the third instalment of the Nightmare Series, hosts Angela Huttner and Thomas Tängdén are joined by enterococcal experts Kimberly Kline (University of Geneva) and Louis Rice (Brown University) to discuss what make vancomycin-resistant enterococci, or VRE, such a clinical nightmare. Enterococcus faecalis and Enterococcus faecium are the focus.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Nunzia Esposito of the University of Naples Federico II, Naples, Italy.

Literature

Stellfox ME et al. J Antimicrob Chemother 14 Feb 2024. doi: 10.1128/mbio.03396-23

Rogers R & Rice LB. Clin Infect Dis 15 Jan 2024. doi: 10.1093/cid/ciad613

Lebreton F et al. Cell 18 May 2017. doi: 10.1016/j.cell.2017.04.027

Donskey CJ et al. N Engl J Med 28 Dec 2000. doi: 10.1056/NEJM200012283432604

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Carbapenemase producers are a nightmare for clinicians. Not only are they resistant to carbapenems, a last resort β-lactam antibiotic, they are notorious for developing multidrug and pandrug resistances resulting in limited to no treatment options. In this episode of Communicable, hosts Angela Huttner and Thomas Tängdén sit down with Dr. David Paterson (National University of Singapore) and Dr. Souha Kanj (American University of Beirut Medical Center, Lebanon), two ID physicians from regions where carbapenem-resistant Enterobacteriaceae or CRE, and carbapenem-resistant Acinetobacter are widespread. The episode begins with the history and emergence of CRE and reviews current epidemiology, diagnosis (including the Ambler classification of β-lactamases) and treatment options. Lessons and insights from personal experiences are shared to reflect the current clinical challenges caused by carbapenem-resistant bacteria and the importance of infection prevention and control measures to mitigate further spread. 

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Filippo Medioli of Policlinico di Modena, Italy. For more related content on the WHO Priority Pathogens List and new antibiotics in the pipeline, check out our previous episodes, Communicable E3 and E10 (see Literature).

Literature 

Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? 2024 June - communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first

Communicable E10 - Pipeline update: new antibiotics & other antimicrobials that you might actually use. 2024 Sep - communicable.transistor.fm/episodes/communicable-e10-pipeline-update-new-antibiotics-other-antimicrobials-that-you-might-actually-use

Wagenlehner FM, et al. Cefepime-Taniborbactam in Complicated Urinary Tract Infection. N Engl J Med 2024 Feb. doi: 10.1056/NEJMoa2304748

Cohn J, et al. Accelerating antibiotic access and stewardship: a new model to safeguard public health. Lancet Infect Dis 2024 Sep. doi: 10.1016/S1473-3099(24)00070-7

Timsit JF, et al. When should I start broad-spectrum antibiotics? Intensive Care Med 2024 Sep. doi: 10.1007/s00134-024-07654-7

Paterson DL. Antibacterial agents active against Gram Negative Bacilli in phase I, II, or III clinical trials. Expert Opin Investig Drugs 2024 Apr. doi: 10.1080/13543784.2024.2326028

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On the verge of a post-antibiotic reality, there is an urgent clinical need for new antibiotics. Luckily, new candidates are in the pipeline and older agents are getting a second breath of life through combination therapy.

In this episode of Communicable, host Erin McCreary invites Dr. Markus Zeitlinger of the University of Vienna (Austria) and scientific expert for the European Medicines Agency (EMA) and Dr. Michael Dudley, president and CEO of Qpex Biopharma, to discuss antimicrobials in the clinical development pipeline. Together they unpack how the WHO curate the priority list of pathogens and how companies adapt such lists into their antimicrobial development business plans. They also discuss the unique challenges and complexities of developing antibiotics, from return on investments and defining the ‘novelty’ of an agent to the conundrum of balancing post-market approval and antimicrobial stewardship. Beta-lactamase inhibitors and oral carbapenems in the pipeline targeting ‘the big three’ (Enterobacterales, Pseudomonas and Acinetobacter) are the primary focus.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Benjamin Berinson of the Medical Centre Hamburg-Eppendorf (UKE), Germany. For more information on the WHO Priority Pathogens List and its 2024 update, check out our previous episode, Communicable E3 (see Literature). 

Literature 

Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? 17 June 2024. https://communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first

WHO Bacterial Priority Pathogens List, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: World Health Organization; 17 May 2024. https://www.who.int/publications/i/item/9789240093461

C. Le Terrier et al, NDM-9 resistance to taniborbactam. Lancet Infect Dis 23, 401-402 (2023). doi 10.1016/S1473-3099(23)00069-5

P. B. Eckburg et al, Oral Tebipenem Pivoxil Hydrobromide in Complicated Urinary Tract Infection. N Engl J Med 386, 1327-1338 (2022). doi: 10.1056/NEJMoa2105462

A Study of Oral Tebipenem Pivoxil Hydrobromide (TBP-PI-HBr) Compared to Intravenous Imipenem-cilastatin in Participants With Complicated Urinary Tract Infection (cUTI) or Acute Pyelonephritis (AP) (PIVOT-PO). https://clinicaltrials.gov/study/NCT06059846

Meiji Seika Pharma Initiated the Global Phase III Clinical Trials of OP0595, a Novel beta-Lactamase Inhibitor for Combatting Antimicrobial Resistance (AMR). Tokyo: Meiji Seika Pharma Ltd; 26 April 2023. https://www.meiji.com/global/news/2023/pdf/230426_01.pdf

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The current H5N1 avian flu outbreak in poultry and dairy cows in the US has raised the alarm on bird flu and its transmission risk across species. At present, the virus has infected 100 million birds across 48 states and 196 dairy herds across 14 states. Luckily, the H5N1 avian flu, which is very lethal in birds, does not transmit easily into humans nor does it cause severe and systemic symptoms when humans are infected. Still, workers most exposed to these infected animals are testing positive with 14 human cases reported so far since 2022. 

In this Communicable episode, hosts Angela and Nav are joined by avian flu expert Ron Fouchier (Erasmus MC Rotterdam, Netherlands) to discuss the most recent developments of the outbreak in the US and the potential risks H5N1 virus poses to humans. Understanding of the virus from its first reported outbreak in Hong Kong in 1997 to its global prevalence today is reviewed. While H5N1 bird flu does not pose as a global human health concern at present, unchecked practices in the dairy, meat, and agricultural industry sectors, in which workers are exposed to the virus, threaten to change the status quo. Learn why the threat is even more paramount in fall when human influenza or seasonal flu is widespread, and to what extent the government should also be involved in prevention and containment measures before it becomes, in Ron’s words, another “missed opportunity.” 

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Simon Galmiche, of the Institut Pasteur, Université Paris Cité, Paris, France.

Literature

US Center for Disease Control and Prevention (CDC), H5 Bird Flu: Current Situation, www.cdc.gov/bird-flu/situation-summary/ (2024).

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Only known to us since 2008, Candida auris is an emerging fungal pathogen spreading quickly around the world; alarmingly, it is most commonly found in healthcare settings. C. auris sets itself apart from other Candida species with its unique tolerance to high saline and temperature environments and propensity to develop antifungal resistances that promote its survival in hospitals and healthcare facilities.

Hosts Emily McDonald and Navaneeth Narayanan are joined by fungal experts Dr. Jeffrey Rybak (St. Jude, Memphis TN) and Dr. Graham Snyder (UPMC, Pittsburgh PA) on their quest to better understand C. auris infections, the clinical challenges and knowledge gaps in C. auris research and discuss measures for prevention and containment on the levels of both the patient and the institution.

The recent emergence of C. auris as a multidrug-resistant nosocomial pathogen and its global prevalence has raised more questions than answers. Why now? Why healthcare facilities? Does climate change play a role? Are humans to blame? Tune in to find out what the experts have to say on these questions, and stay to learn about the current therapies available, what is in the antifungal pipeline and how to approach treatment from a stewardship standpoint.

This episode was produced by Angela Huttner, edited by Kathryn Hostettler and peer-reviewed by Dr. Claudio Neidhöfer of University Hospital Bonn, Germany.

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On the verge of a post-antibiotic reality, there is an urgent clinical need for new antibiotics. Luckily, new candidates are in the pipeline and older agents are getting a second breath of life through combination therapy. In this episode of Communicable, host Erin McCreary invites Dr. Markus Zeitlinger of the University of Vienna (Austria) and scientific expert for the European Medicines Agency (EMA) and Dr. Michael Dudley, president and CEO of Qpex Biopharma, to discuss antimicrobials in the clinical development pipeline.  Together they unpack how the WHO curate the priority list of pathogens and how companies adapt such lists into their antimicrobial development business plans. They also discuss the unique challenges and complexities of developing antibiotics, from return on investments and defining the ‘novelty’ of an agent to the conundrum of balancing post-market approval and antimicrobial stewardship. Beta-lactamase inhibitors and oral carbapenems in the pipeline targeting ‘the big three’ (Enterobacterales, Pseudomonas and Acinetobacter) are the primary focus. This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Benjamin Berinson of the Medical Centre Hamburg-Eppendorf (UKE), Germany. For more information on the WHO Priority Pathogens List and its 2024 update, check out our previous episode, Communicable E3 (see Literature).  

Literature

Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? 17 June 2024. https://communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first

WHO Bacterial Priority Pathogens List, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: World Health Organization; 17 May 2024. https://www.who.int/publications/i/item/9789240093461  

C. Le Terrier et al, NDM-9 resistance to taniborbactam. Lancet Infect Dis 23, 401-402 (2023). doi 10.1016/S1473-3099(23)00069-5      

P. B. Eckburg et al, Oral Tebipenem Pivoxil Hydrobromide in Complicated Urinary Tract Infection. N Engl J Med 386, 1327-1338 (2022). doi: 10.1056/NEJMoa2105462  

A Study of Oral Tebipenem Pivoxil Hydrobromide (TBP-PI-HBr) Compared to Intravenous Imipenem-cilastatin in Participants With Complicated Urinary Tract Infection (cUTI) or Acute Pyelonephritis (AP) (PIVOT-PO). https://clinicaltrials.gov/study/NCT06059846 

Meiji Seika Pharma Initiated the Global Phase III Clinical Trials of OP0595, a Novel beta-Lactamase Inhibitor for Combatting Antimicrobial Resistance (AMR). Tokyo: Meiji Seika Pharma Ltd; 26 April 2023. https://www.meiji.com/global/news/2023/pdf/230426_01.pdf 

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Responsible for 1.3 million deaths and 2.2 million new infections per year, viral hepatitis is the second leading cause of morbidity and mortality amongst all infectious diseases, just behind tuberculosis.  

Hosts Angela Huttner and Oana Sandulescu welcome special guest and leading hepatitis expert, Professor Mojca Matičič, MD, PhD (Ljubljana, Slovenia), to refresh your knowledge on the pathogenesis of hepatitis B & C infections, review the latest direct-acting antiviral (DAA) therapies, map out some countries’ successful elimination initiatives, and understand challenges remaining for others.

In recognition of World Hepatitis Day this Sunday, 28 July, a day dedicated to raising awareness about viral hepatitis, we are releasing our latest episode a few days early. The World Hepatitis Day theme this year is: it’s time for action! The Communicable team urges our listeners to inform themselves and others, and to test, treat, and vaccinate against viral hepatitis.

This episode was peer reviewed by Dr. Liem Luong of CIC Cochin Pasteur, Hôpital Cochin-Port Royal, Assistance Publique-Hôpitaux de Paris, Paris, France.

Literature:

  • World Hepatitis Day 2024: It’s time for action. Geneva: World Health Organization; 2024: https://www.who.int/
  • Method for global reporting on disease burden and service coverage data for viral hepatitis B and C, 2022. In: Global hepatitis report 2024: action for access in low- and middle-income countries. Geneva: World Health Organization; 2024. doi: 10.2471/B09024.
  • The European Association of the Study of the Liver (EASL). EASL Congress Milan, Italy 5-8 June 2024. doi: https://www.easlcongress.eu
  • European Centre for Disease Prevention and Control (ECDC). ECDC Evidence brief: Prevention of hepatitis B and C in the EU/EEA. Stockholm: ECDC; 2024.
  • European Centre for Disease Prevention and Control. Hepatitis C. In: ECDC. Annual epidemiological report for 2022. Stockholm: ECDC; 2024.
  • Burnet Institute and Kirby Institute. Australia’s progress towards hepatitis C elimination: annual report 2022. Melbourne: Burnet Institute; 2022.
  • Maticic M, Pirnat Z, Leicht A, et al. The civil society monitoring of hepatitis C response related to the WHO 2030 elimination goals in 35 European countries. Harm Reduct J. 2020 Nov 19;17(1):89. doi: 10.1186/s12954-020-00439-3.

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The ‘I’ (intermediate susceptibility) in a EUCAST-guided antibiogram never meant impending resistance to your antibiotic. It was never meant to make you find the one ‘S’ (invariably a carbapenem) and use it instead—even if many clinicians did. 

In this episode of Communicable, hosts Marc Bonten and Angela Huttner welcome Profs. Christian Giske (outgoing chair) and Sören Gatermann (newly elected chair) of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) to discuss its recent updates, including the new ‘susceptible dose dependent’ (SDD) label, and to shed light on common misconceptions around the way it sets breakpoints. Breakpoints for Pseudomonas aeruginosa are discussed, as are intravenous fosfomycin’s ‘disappearance’ from the breakpoints table and EUCAST’s new guidance on it. Episode peer-reviewed by Dr. Suzanne van Asten of Radboud University Medical Center.

Literature:

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Hosts Angela Huttner & Erin McCreary welcome Prof. David Paterson (Singapore) and Prof. Josh Davis (Newcastle, Australia) to discuss the design and results of the BLING-3 trial, which compared continuous infusion of beta-lactam antibiotics to standard intermittent dosing in 7000 critically ill patients across 104 intensive-care units. In unadjusted analyses, the trial did not show a statistically significant mortality benefit with continuous infusion. Yet in prespecified adjusted analyses, there was a statistically significant reduction in mortality, and a meta-analysis of randomized trials published simultaneously with the BLING-3 trial showed the same. As the two ID doctors on the BLING team, Profs. Paterson and Davis offer context and insights into what these results mean and how they might affect your clinical practice. Episode peer-reviewed by Dr. Mia Lidén of Charité – Universitätsmedizin Berlin.

Literature:

  • BLING-1: Dulhunty et al. Continuous infusion of beta-lactam antibiotics in severe sepsis: a multicenter double-blind, randomized controlled trial. Clin Infect Dis. 2013 Jan;56(2):236-44. DOI: 10.1093/cid/cis856
  • BLING-2: Dulhunty et al. A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis. Am J Respir Crit Care Med. 2015 Dec 1;192(11):1298-305. DOI: 10.1164/rccm.201505-0857OC
  • BLING-3: Dulhunty et al. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. JAMA. 2024 Jun 12:e249779.DOI: 10.1001/jama.2024.9779
  • Meta-analysis: Abdul-Aziz et al. Prolonged vs Intermittent Infusions of β-Lactam Antibiotics in Adults With Sepsis or Septic Shock: A Systematic Review and Meta-Analysis. JAMA. 2024 Jun 12:e249803. DOI: 10.1001/jama.2024.9803

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What are WHO's most wanted bacterial pathogens in 2024? Hosts Angela Huttner & Oana Sandulescu welcome guests Dr. Hatim Sati of the World Health Organisation (WHO) and Dr. Erin Duffy (CARB-X) to discuss WHO’s new Priority Pathogens List. Developed by WHO and a panel of global experts, the List identifies the ‘top’ bacteria for which research & development are of critical, high, and medium priority, and thus serves as a framework for resource allocation and public-policy guidance. Episode peer-reviewed by Dr. Galadriel Pellejero of Lozano Blesa Clinical Hospital, Zaragoza, Spain.

Literature:
WHO bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance.
https://www.who.int/publications/i/item/9789240093461

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In this episode, hosts Josh Davis (Newcastle, Australia) and Angela Huttner (Geneva, Switzerland) interview the phage ‘microbiologist-clinician duo’, Drs. Shawna McCallin and Lorenz Leitner (Balgrist Hospital, Zurich, Switzerland). They explore the history of phages, the process of bringing phage therapy to a patient, potential resistance to phages, availability of individualized therapy versus phage cocktails, and the place of phage therapy in the future. Drs. Leitner and McCallin reflect on the challenges and lessons of their recently published randomized trial comparing phage therapy to antibiotics for urinary tract infection. Episode peer-reviewed by Dr. Olivia Funk of Long Island University. 

Literature:
Leitner L, Ujmajuridze A, Chanishvili N et al.  Intravesical bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomised, placebo-controlled, double-blind clinical trial. Lancet Infect Dis. 2021 Mar;21(3):427-436. doi: 10.1016/S1473-3099(20)30330-3. 

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CMI Communications editors Angela Huttner, Marc Bonten, and Erin McCreary discuss late-breaker clinical trials presented at ESCMID Global (ECCMID) 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 bacteremia. 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. Episode peer-reviewed by Dr. Yousra Kherabi.

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