Wendy Stead

Orthopedic implant infections—including prosthetic joint infections (PJI), fracture-related infections (FRI), and spinal implant infections (SII)—represent a spectrum of biofilm-associated infections that are associated with substantial morbidity, prolonged antimicrobial therapy, and frequent need for surgical intervention. Rifampin is often incorporated into antimicrobial treatment regimens for orthopedic implant infections due to its potent biofilm-penetrating properties and has been most studied in the treatment of staphylococcal PJIs, though the majority of data is observational. Its use is frequently complicated by adverse effects and significant drug–drug interactions, and the role of rifampin beyond staphylococcal PJIs managed with implant retention or one-stage exchange remains controversial. In this review, we critically evaluate the evidence for use of rifampin in PJI, with additional consideration of its role in FRIs, SIIs, and PJIs caused by staphylococcal and other Gram-positive organisms. Using illustrative cases, we provide a practical framework for navigating common clinical scenarios and challenges involving the use of rifampin in orthopedic implant infections.

Advocacy has long been at the core of the infectious diseases (ID) field, with clinicians and researchers advocating to ensure patients can access the care they need on an individual and global scale. The Infectious Diseases Society of America Training Program Directors’ (PD) Committee met in 2024 and discussed ways that advocacy is and should be incorporated into fellowship training, as well as highlighted the role PDs play in advocating for their trainees. Policies with a negative impact on ID clinical care, public health, and research underscore the importance of mobilizing the field of ID to advocate for the patients and communities we serve, as well as for ourselves. This paper presents ideas generated at this meeting and is meant to serve as a reference for ID PDs, as well as the wider ID community, as a call to action for teaching and participating in advocacy work.

Climate change has substantial implications for infectious diseases. The infectious diseases community must rapidly expand its understanding of these dynamics; formal training for physicians is urgently needed. Here, we describe the learning objectives, educational strategy, and implementation of a pilot Climate Change training pathway within an infectious diseases fellowship.

From a childhood spent playing hundreds of softball games across the fields of central Massachusetts, I have many happy memories of being part of a cohesive team. We experienced wins and losses, exceptional and not-so-exceptional coaches, parents who cheered for us and parents who screamed unrestrainedly at the umpires. But the priority was always the success of the team, to which we brought our individual talents. Whether it was throwing strikes, hitting home runs, or rabidly arguing the call at home plate, everyone did their part. Nobody was happy as a bystander on the sidelines. Those childhood lessons continue to infuse my work today on multidisciplinary teams as an Infectious Diseases (ID) consultant; the team functions best when our skills are sharp, and we are fiercely invested in the game and each other.

Background: Febrile is an infectious diseases (ID) podcast and learning platform with the aim of providing high-quality and accessible ID content for learners. We describe the use of Febrile as a resource for learning and teaching ID as well as learner satisfaction and perceived impact on clinical practice. Methods: The Febrile platform was launched in December 2020 and includes audio podcast episodes, infographics, and detailed online summaries of adult and pediatric ID topics. Production and contributor information is summarized. Podcast, website, and social media engagement is reported from available quantitative analytics. An online anonymous survey was conducted to assess educational impact. Results: After 3 years of operation, Febrile has produced 90 episodes and has been downloaded >460 000 times in 196 countries, with the majority of its audience (58.9%) listening from within the United States. A total of 230 participants from 30 countries and 38 US states completed the survey, of whom 79 (34.5%) were ID fellows in training and 78 (34.2%) were ID faculty physicians. Seventy-two percent of survey respondents reported visiting the website, and 82% had seen an infographic. Enhancing core ID knowledge was the primary driver for listening. Two-thirds of respondents indicated that information learned from Febrile has changed their practice, and 50% have used Febrile as a way to teach others. Febrile also led to favorable impressions of ID for those considering ID as a career. Conclusions: Febrile is an engaging platform for ID medical education and provides a unique resource within the global ID community.

Background: Many physician trainees plan pregnancy during residency and fellowship. A study of internal medicine program directors (PDs) demonstrated frequent misinterpretation of American Board of Internal Medicine (ABIM) leave policies applied to parental leave. The primary aim was to investigate how infectious disease (ID) PDs interpret current ABIM leave policies. Methods: We surveyed 155 ID PDs in an online anonymous questionnaire about knowledge of ABIM leave policies and application toward trainee leaves. Results: Of 155 PDs, 56 (36%) responded to the survey. Nearly 70% incorrectly identified leave limits permitted. A majority mistakenly chose to extend training when a competent fellow was within the allowed duration of leave. PDs reported that the majority of ID trainee maternity/birth parent leaves (60%) were ≤7 weeks and only 7% were ≥12 weeks; 50% of paternity/nonbirth parent leaves were ≤3 weeks. Conclusions: Surveyed ID fellowship PDs often misinterpret ABIM leave policies and apply policies incorrectly when given sample scenarios..

I know you carry themnot in an album or a jpg file, but thumb-tacked to your brainThey come unexpectedlya deer sighting on a cold early morning runyour daughter

Background: Little is known about antimicrobial prescribing when patient care is transitioned to comfort measures only (CMO). We used a multidisciplinary survey and retrospective cohort study to gain insight into antimicrobial prescribing in this population at an academic medical center to inform future antimicrobial stewardship interventions. Methods: A survey focusing on antimicrobial prescribing during the transition to CMO was electronically distributed to providers in medical subspecialities and responses were compared across specialties. A retrospective chart review was performed of patients admitted to an academic medical center in 2020 who were on antimicrobials in the 48 hours prior to CMO. We investigated the percentage of patients who remained on antimicrobials after the transition to CMO and rationale for continuing antimicrobials. Results: We received 113 survey responses (35% response rate). Forty-one percent of respondents indicated that they “sometimes” or “often” continued antimicrobials during the transition to CMO. Patient/family preference and symptom palliation were the most common factors cited by respondents when deciding whether to continue antimicrobials in this population. Of the 546 patient charts reviewed, 140 (26%) patients were alive 48 hours after CMO order, and 19 (14%) of those patients remained on antimicrobials. Five of 19 (26%) patients had documentation that antimicrobials were continued due to patient/family preference and 5 of 19 (26%) patients had documentation that antimicrobials were continued for palliation of symptoms. Conclusions: Patient/family preference and symptom palliation are important factors in prescribing antimicrobials when patient care is transitioned to CMO. More evidence is needed regarding palliative benefits of antibiotics to inform provider discussions of benefits and harms of antimicrobial use in this setting.

Background: Gender inequities in academic advancement persist in many specialties, including Infectious Diseases (ID). Prior studies of advancement disparities have been predominantly quantitative, utilizing large physician databases or surveys. We used qualitative methods to explore ID physicians’ experiences and beliefs about causes and ways to mitigate gender inequities in advancement. Methods: We conducted semistructured focus group discussions with academic ID physicians in the United States at IDWeek 2019 to explore perceived barriers and facilitators to academic advancement. Participants were assigned to focus groups based on their academic rank and gender. We analyzed focus group transcripts using content analysis to summarize emergent themes. Results: We convened 3 women-only focus groups (1 for instructors/assistant professors, 1 for associate professors, and 1 for full professors) and 1 men-only focus group of full professors (total N = 50). Our analyses identified several major themes on barriers to equitable academic advancement, including (1) interpersonal and institutional gender bias, (2) difficulty balancing the demands of family life with work life, and (3) gender differences in negotiation strategies. Conclusions: Barriers to gender equity in academic advancement are myriad and enduring and span the professional and personal lives of ID physicians. In addition to swift enactment of policy changes directed at critical issues such as ending workplace harassment and ensuring adequate parental leaves for birth and nonbirth parents, leaders in academic medicine must shine a bright light on biases within the system at large and within themselves to correct these disparities with the urgency required.

In this narrative medicine essay, an infectious diseases physician recounts a minor breakthrough in her efforts to convince her patient to get a COVID-19 vaccin