SYMPOSIUM 197—CLINICAL TRIALS THAT WILL CHANGE YOUR PRACTICE, WEDNESDAY, OCTOBER 22, 2025 Bacteriology Presented by Amy Mathers, MD Treatment of Male Partners Prevents Recurrence of Bacterial Vaginosis (BV) This was an open-label, randomized controlled trial published in the New England Journal of Medicine. Women who were diagnosed with BV and their partners were enrolled and randomized to either standard treatment (ie, the woman treated with oral metronidazole, and the partner received no treatment) versus the woman treated with standard oral meds, and the partner received oral metronidazole 400 mg po BID plus 2% clindamycin cream applied to penile skin. Exclusion criteria included HIV and women with multiple partners. Randomization was also stratified based on circumcision and IUD use since both are risk factors. At 12 weeks, the intention-to-treat population (partner treated) had a 35% recurrence rate, while the control group (partner not treated) had a 63% recurrence rate. The study was stopped early due to the effectiveness of the partner-treated group. There were 2 patients for whom adherence was an issue.1 Comments by Dr Ponnapalli: This is a very useful study that would lead me to treat the male partners of patients with BV. Counseling them on adhering to the topical clindamycin despite irritation is important, since it appears the clindamycin cream is likely more effective than oral metronidazole alone for treatment of partners. Oral Gepotidacin for Uncomplicated Urogenital Gonorrhea (EAGLE-1) Gepotidacin is a triazaacenaphthylene antibacterial that inhibits bacterial DNA replication. It has a unique mechanism of action, and there is no cross-resistance with other antibiotics. EAGLE-1 was a phase 3, open-label, sponsor-blinded, noninferiority study conducted at multiple international sites. As a single dose of the drug caused the emergence of resistance, the regimen chosen was 2 doses. Patients with gonorrhea were randomized to 2 doses of gepotidacin given orally 10 to 12 hours apart, or ceftriaxone 500 mg intramuscularly and azithromycin 1 gm by mouth. Exclusion criteria included significant immunocompromise, but HIV patients with CD4 counts ≥200 cells per mm2 were included. The youngest person enrolled was 16. The study population was predominantly male, white, and men who had sex with men (MSM). Sixty-five percent of gonorrhea grew in cultures, so susceptibilities were done, even across the groups. The gepotidacin was 100% effective, equivalent to the ceftriaxone/azithromycin group. Gastrointestinal side effects were higher with gepotidacin.3 Comments by Dr Ponnapalli: In patients with resistant gonorrhea, gepotidacin would be a useful drug to have in our armamentarium. However, this study is difficult to generalize to women since patients were predominantly male. They did include patients with rectal and pharyngeal gonorrhea, but numbers were smaller, so they could not say that gepotidacin was as effective at those sites. Dalbavancin for Staphylococcus aureus Bacteremia (DOTS) DOTS was a multicenter, open-label, randomized superiority trial. Patients were treated with effective antibacterials for >72 hours and <10 days, then randomized to standard of care versus dalbavancin. Patients with left-sided endocarditis, central nervous system infections, infections of prosthetic material, and severe immunocompromise were excluded. The dalbavancin group received 1500 mg doses of dalbavancin at days 1 and 8, while the standard care group received 4 to 8 weeks of conventional therapy. The primary outcome was determined by DOOR (desirability of outcome ranking). The questions asked were less useful, that is, doing household chores instead of asking about admission to subacute rehabilitation facilities. The groups were well matched. Outcomes were similar, with similar clinical efficacy. Dalbavancin was not demonstrated to be superior to standard therapy.2 Comments by Dr Ponnapalli: Patients with Staphylococcus aureus bacteremia are often sent home or to SAR with long courses of treatment. This study shows the efficacy of dalbavancin, which would be much less cumbersome for the patient and can be used in patients who cannot go home with intravenous lines, such as PWID. Antibiotic Treatment for 7 Days Versus 14 Days in Patients With Bloodstream Infections: Open Label, Randomized, Controlled Trial Across 7 Countries: The Balance Trial Over 3600 patients with bacteremia were enrolled in the trial and randomized to either 7 days of antibiotics or 14 days of antibiotics. The groups were well matched with different bacteria, including Gram positives and Gram negatives. Staphylococcus aureus, Staphylococcus lugdunensis, and Candida species were not included. The primary outcome was death from any cause at 90 days. Enrollees included both ICU and non-ICU patients. Seven days was noninferior (4% margin) to 14 days.4 The same group published a clinical decision tool to help identify which patients should not be given 7 days. Criteria that might support longer therapy include immunosuppression, prolonged bacteremia, continued signs of sepsis, lack of source control, and unknown source.5 Comments by Dr Ponnapalli: This study, which was done in sick ICU patients and in non-ICU patients, will help with stewardship by reducing the use of antibiotics in hospitalized patients and reducing adverse effects from antibiotics. Aztreonam-Avibactam Versus Meropenem for the Treatment of Gram-Negative Infections Caused by Gram-negative Bacteria (REVISIT) This was a prospective, randomized, open-label study. Patients with complicated intra-abdominal infections (cIAI) (70%) and hospital-acquired pneumonia were randomized to aztreonam-avibactam or meropenem. Excluded were very sick patients. Metronidazole was added for cIAI. A relatively small percentage of patients had metallo-β-lactamase. It was effective for cIAI, but there was not enough data for HAP/VAP.6 Comments by Dr Ponnapalli: The study design was flawed in that the patients did not all have resistant organisms; only one quarter of the isolates tested were carbapenemase positive. Thus, it is not a compelling study since the numbers were so small. Cefiderocol Versus Standard Therapy for Hospital-Acquired and Health Care–Associated Gram-Negative Bacterial Infections (GAME CHANGER) This was an open-label, randomized clinical trial of patients with hospital-acquired Gram-negative bacteremia who were randomized to cefiderocol or standard therapy. The primary outcome was all-cause mortality at 14 days (10% margin of noninferiority). Twenty-five percent of isolates were carbapenem-resistant. Cefiderocol was noninferior overall and with carbapenemase-resistant bacteria in general, but the cefiderocol group had higher mortality in patients with metallo-β-lactamase–producing Enterobacterales.7 Comments by Dr Ponnapalli: Cefiderocol can be used in patients with Gram-negative bacteremia, but patients with metallo-β-lactamase producers did worse on cefiderocol, suggesting that further study is needed. Dr. Barbara Alexander Presented “Trials in Mycology That Can Change Your Practice” Among the papers cited, she mentioned publication of guidelines for the management of Candidiasis,8 with a take-home message that echinocandins remain first line for invasive candidiasis, and a caveat that local resistance will dictate practice. She emphasized that susceptibilities should be run for severe fungal infections or those that do not respond to treatment. She also cited references on Coccidiomycosis. A JAMA Network Open paper suggested that coccidiomycosis was greatly underestimated.9 Another paper studied the profound effect of diabetes on coccidiomycosis. Diabetics with coccidiomycosis had a greater chance of severe disease, including hospitalization and development of cavitary disease. For uncontrolled diabetics, the higher the hemoglobin A1C, the greater the risk of hospitalization and cavitary lung lesions.10 Vodstrcil LA, Plummer EL, Fairley CK, et al. Male-partner treatment to prevent recurrence of bacterial vaginosis. N Engl J Med. 2025;392:947-957. Turner RA, Hamasaki T, Doernberg SB, et al. Dalbavancin for treatment of Staphylococcus aureus bacteremia. The DOTS Randomized Clinical Trial. JAMA. 2025;334(10):866-877. Ross JD, Wilson J, Workowski KA, et al. Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1): a phase 3 randomized, open-label, non-inferiority, multicentre study. Lancet. 2025;405(10489):1608-1620. The Balance Investigators. Antibiotic treatment for 7 versus 14 days in patients with bloodstream infections. N Engl J Med. 2025;392(11):1065-1078. Ong SW, Pinto R, Rishu A, Tong SY. Identifying heterogeneity of treatment effect for antibiotic duration in bloodstream infection: an exploratory post-hoc analysis of the BALANCE randomised clinical trial. Lancet eClin Med. 2025;83:103195. Carmeli Y, Cisneros JM, Paul M, et al. Aztreonam-avibactam versus meropenem for the treatment of serious infections caused by Gram-negative bacteria (REVISIT): a descriptive, multinational, open-label, phase 3, randomised trial. Lancet Infect Dis. 2025;25(2):218-230. Paterson DL, Sulaiman H, Liu PY, Chatfield MD. Cefiderocol versus standard therapy for hospital-acquired and health-care-associated Gram-negative bacterial bloodstream infection (the GAME CHANGER trial): an open-label, parallel-group, randomised trial. Lancet Infect Dis. 2025;S1473-3099 (25)00469-4. Cornely O, Sprute R, Bassetts M, Chen SC. Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis May 2025;25(5):e2 Williams SL, Benedict K, Jackson BR, Rajeev M. Estimated burden of coccidiomycosis. JAMA Netw Open. 2025;8(6):e251357 El Kurdi R, McGary A, Buras MR et al. The profound effect of diabetes mellitus control on outcomes of coccidiomycosis. Med Mycol. 2025;63 mya 1004. SESSION 23—AI IN ID EDUCATION AND FELLOWSHIP, MONDAY, OCTOBER 20, 2025. MODERATORS: SETH COHEN, MD, EMILY ABDOLER, MD, MAeD. FACULTY: ALFREDO MENA LORA, MD, CORNELIUS JAMES, MD, RACHEL SIGLER, DO, PMH AI: machines simulating human intelligence to perform tasks like learning and reasoning. Large language model: AI algorithms trained on large text data sets to generate and understand human-like language. Dr Sigler discussed the use of AI in medical education. She noted that most medical students are already taking advantage of the new technology, for example, using AI platforms such as ChatGPT and Claude to test themselves. AI learning can be personalized to the learner, provide relevant resources, and encourage critical thinking over memorization. When doing case studies, AI can respond with progressive case complexity. Dr Sigler gave an example used at her institution: A Chatbot was used to simulate typical interactions, such as the antimicrobial stewardship pager, with cases such as MSSA bacteremia with a port in place. The learner enters replies to queries, and AI critiques the responses. Dr James stressed that AI was already in use, and technology will not wait for clinicians to catch up. He discussed its use in clinical reasoning and developing clinical skills. He cited a study where ChatGPT scored higher than physicians with conventional resources, though he also described limitations to the study.1 In a paper published in Academic Medicine, he recommended understanding foundational AI concepts, becoming familiar with institutional polices on AI, and obtaining access to AI. In addition, physicians should discuss AI with their patients and learn how the rest of the medical community is using AI, including in medical education.2 He did feel strongly that the use of AI should be integrated into the medical school curriculum. He mentioned how physicians might use AI to offload, for example, as a personal scribe, or to aid in collaborating with patients. Dr Lora discussed using AI for fellowship recruitment. He mentioned using AI to improve social media content and showed some demonstration 60-second videos which can be created with minimal expense and effort, to market your program to prospective applicants. AI can also be used to synthesize applicant data, making it easier to review pre- and post-interview. Comments by Dr Louie: it is imperative that ID physicians become familiar with AI and leverage it to improve our efficiency and effectiveness as clinicians. Goh E, Gallo R, Hom J, et al. Large language model influence on diagnostic reasoning: a randomized clinical trial. JAMA Netw Open. 2024;7(10):e2440969. Rodman A, James CA. Effective engagement with AI is the only path forward for clinician-educators. Acad Med. 2025;100(9S suppl 1):S46-S48. SESSION 161, ORAL ABSTRACT 404. GENOMIC SURVEILLANCE REVEALS REDUCED STAPHYLOCOCCUS AUREUS TRANSMISSION IN SEMI-PRIVATE VERSUS MULTI-BED HOSPITAL ROOMS. TUESDAY, OCTOBER 21, 2025. AUTHORS: TAKATS C, PIRONTI A, SHOPSIN B, PUTZEL G, PODKOWIK MM, TILLMAN A, SHENDEROVICH J, ARGUELLES NM, SRIVASTAVA A, PHILIPS M, HOCHMAN SE Investigators examined ~5000 isolates of Staphylococcus aureus from 4000 patients collected over a 14-month period. Eighty-five percent of these isolates were obtained from standard surveillance cultures, and the remaining were clinical isolates (blood, sputum, or wound sources). Every isolate underwent whole-genome sequencing. Investigators then looked for closely related isolates defined as having <20 single-nucleotide polymorphisms. From these closely related samples, investigators further identified isolates that could be epidemiologically linked by timestamped patient location data, which were then categorized as high-probability transmissions. There were 192 high-probability transmissions during the 14-month period. Seventy-five percent of these were identified using screening cultures. The rate of high-probability transmissions was then compared between single, 2-bedded, and 4-bedded rooms. Transmission rates were 0.5 per 1000 admissions in single rooms, 1.2 per 1000 admissions in 2-bedded rooms, and 4.4 per 1000 admissions in 4-bedded rooms. Overall, this indicates that the risk of Staphylococcus aureus transmission increases with the number of patients in a room. Comments by Dr Stephen: Since at least the time of Ignaz Semmelweis, professionals who focus on preventing infections have often been challenged by a lack of direct causative evidence supporting infection prevention practices. While many basic infection prevention principles seem to be common-sense practices, health care providers and those in charge of system policy often require evidence to justify why specific interventions are necessary. In the case of hospital spread of infectious organisms, it can be very difficult to prove that infection prevention interventions are directly causative of improvements in outcomes. This is particularly relevant when considering practices such as single versus multibed hospital rooms, which can have significant financial implications for the hospital system as well. Some prior work has shown a decreased rate of MRSA acquisition in single-bed rooms1,2; however, it is not clear from their study designs whether the increased acquisition is due to genetically related isolates. And so, while the practice is supported, the full causative reasoning is not proven. This study, which utilized whole-genome sequencing on a data set comprising thousands of isolates, was able to identify settings where the temporally associated acquisition of a genetically related bacterium is clearer. This provides some of the most robust data to demonstrate the benefits of private rooms from an infection prevention standpoint, suggesting that transmission may be prevented from one patient to another within a multi-bed room. This has implications for hospitals and health care systems when building new facilities. It may also help support enhanced infection prevention strategies in multi-bed rooms. More broadly, the study highlights the potential benefits of screening for bacterial colonization to identify nonapparent hospital transmissions. Bracco D, Dubois MJ, Bouali R, Eggimann P. Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med. 2007;33(5):836-840. McDonald EG, Dendukuri N, Frenette C, Lee TC. Time-series analysis of health care-associated infections in a new hospital with all private rooms. JAMA Intern Med. 2019;179(11):1501-1506. SESSION 109, ORAL ABSTRACT 291—DURATION OF ANTIBIOTIC THERAPY FOR UNCOMPLICATED GRAM-NEGATIVE BACTEREMIA IN SOLID ORGAN TRANSPLANTATION, OCTOBER 21, 2025. AUTHORS: CAPPUCIO WR, HEIL EL, BOOTH M, BARNES A, CLAEYS KC, SEUNG H, LEE S The optimal treatment duration for Gram-negative bacteremia (GNB) in solid organ transplant (SOT) patients remains unknown. Large, randomized controlled trials and meta-analyses have demonstrated that a 7-day course is noninferior to a 14-day course for GNB; however, solid organ transplant patients are significantly underrepresented in these study cohorts.1 There was a multicenter, retrospective study that compared treatment duration outcomes of Pseudomonas aeruginosa, which included both immunocompetent (35%) and patients This included patients such as solid organ and patients, and no in mortality between and prolonged course However, the was to days and did not for other health patient outcomes. There was also a retrospective study conducted in which that infection recurrence and mortality were similar transplant who received to 10 versus long courses to of However, further were to these to other solid organ transplant patients. This study, conducted at the of compared the clinical outcomes of all solid organ transplant patients with bacteremia with versus long antibiotic Clinical outcomes were using a of based on adverse of an Gram-negative bacterium in the and There was no in DOOR between the 2 treatment suggesting that prolonged do not improve clinical Comments by Dr Antibiotic stewardship is particularly in transplant patients, given their This to a higher risk for and the of clinical trials on this patient population to It difficult to provide guidelines for the duration of treatment for in solid organ transplant patients. This study further evidence that of antibiotic therapy may be in some solid organ transplant patients with The in the between this study and that mentioned there may be some to these There are multiple limitations to when considering the of these This study noted that patients with a source of bacteremia from a had a duration of antibiotics compared with those with an Thus, it is to that antibiotic courses are for infections that lead to this study did not between patients with versus the of phase patients with may require longer courses of antibiotic therapy. In addition, the of therapy and the of other could the risk of of with of antibiotic therapy. are to further the and outcomes based on the infectious of infection and of therapy. It would also be to the to include patients from multiple in a prospective study. D, E, et al. Bacteremia Seven versus 14 days of antibiotic therapy for uncomplicated Gram-negative a noninferiority randomized controlled trial. Infect Dis. J, et al. Antibiotic therapy for Pseudomonas bloodstream how long is long Infect Dis. T, K, S et al. The effectiveness and of the therapy in transplant with uncomplicated Gram-negative a retrospective study. Infect Dis. of antibiotic therapy for uncomplicated Gram-negative bacteremia in solid organ Oral 2025. D, et al. an the to antimicrobial stewardship in transplant infectious Infect Dis. H, is the case for antibiotic courses for infections in solid organ transplant Infect Dis.
Ponnapalli et al. (Wed,) studied this question.