Jonathan Ryder, MD @jonathanrydermd

Opinion | I'm an Infectious Diseases Doctor. Our Pipeline of Experts Is in Distress. Sidelining our field will inevitably leave us all unprepared for the next threat

I'm an Infectious Diseases Doctor. Our Pipeline of Experts Is in Distress. www.medpagetoday.com/opinion/seco... "A world that sidelines ID now will inevitably find itself unprepared for the next microbial threats which, truthfully, are already here." Well stated @boghuma.bsky.social

09.12.2025 20:28 — 👍 11 🔁 7 💬 0 📌 0

Infectious Diseases Society of America (IDSA) Position Statement: Why IDSA Did Not Endorse the Community-Acquired Pneumonia Guidelines 2025 Update The Infectious Diseases Society of America (IDSA) did not endorse updated community-acquired pneumonia guidelines because they recommend antibiotics for pa

A @idsainfo.bsky.social position statement in @cidjournal.bsky.social describing why the society backed out of ATS CAP guidelines.

[In viral pneumonia] “briefly withholding antibiotics for patients with nonsevere illness to clarify the diagnosis is safe”

#IDSky

academic.oup.com/cid/advance-...

08.12.2025 23:58 — 👍 11 🔁 4 💬 1 📌 0

Chain of events:
🦨 Skunk → donor scratch → 🏥
• 1️⃣ Kidney recipient (MI) → 💀 5 wks: tremors, weakness, confusion, urinary incontinence
• 🧬 CDC: Rabies RNA detected postmortem (brain)
• 3️⃣ Cornea recipients → ✂️ Explant + 💉 PEP
• 370 exposed → 46 👩‍⚕️ HCWs needed 💉
4️⃣th U.S. organ-derived rabies case #idsky

08.12.2025 18:06 — 👍 3 🔁 2 💬 1 📌 0

Rabies Despite Post-Exposure Prophylaxis in High-Burden Settings: Vaccine Failure or Gaps in Healthcare Delivery? This study reviewed 89 rabies cases from India who had initiated PEP, and identified three “true” breakthrough infections. The findings reveal critical gap

Rabies rarely breaks through PEP in high prevalence regions. In this retrospective review, authors identified 3 true breakthrough cases of 89 possible cases.

They concluded most apparent PEP failures result from gaps in healthcare delivery. #IDSky

academic.oup.com/cid/advance-...

08.12.2025 13:58 — 👍 4 🔁 1 💬 1 📌 0

Impact of vaginal estradiol on the genitourinary syndrome of menopause, vaginal microbiome and mucosal immune mediators in women living with HIV AbstractBackground. Women with HIV (WWH) experience early onset menopause and symptoms may impact antiretroviral therapy (ART) adherence. Vaginal estradiol

Women w/ HIV have earlier menopause but benefit of estradiol for relief of genitourinary symptoms in women on ART is unclear.

In RCT, estradiol improved vaginal maturity & most bothersome symptom, w/ younger age associated w/ improvement in vaginal sx index. #IDSky

academic.oup.com/cid/advance-...

08.12.2025 13:55 — 👍 2 🔁 1 💬 0 📌 0

a man wearing sunglasses and a white t-shirt is holding something in his hands . ALT: a man wearing sunglasses and a white t-shirt is holding something in his hands .

Here’s a short skeetorial to raise awareness about the surprisingly high sodium content in some IV antibiotics...clinically important for patients with CHF. Judicious use matters!💧🧂 #emimcc #medsky #EMsky #IDsky #pharmsky #AMSky #FOAMed

08.12.2025 09:28 — 👍 22 🔁 7 💬 1 📌 2

We are excited to welcome 3 new incoming ID fellows to UNMC ID this upcoming academic year! Congratulations!! #IDSky #Match2026

08.12.2025 16:24 — 👍 4 🔁 1 💬 0 📌 0

Op-ed: I’m a Nebraska doctor focused on public health. Vaccines do not cause autism In a World-Herald op-ed, a Nebraska epidemiologist rebuts health secretary Robert Kennedy Jr. and says that vaccines do not cause autism.

In a World-Herald op-ed, a Nebraska epidemiologist rebuts health secretary Robert Kennedy Jr. and says that vaccines do not cause autism.

07.12.2025 14:03 — 👍 5 🔁 4 💬 0 📌 0

Haha yup, not limited to Boston!

06.12.2025 20:24 — 👍 2 🔁 0 💬 1 📌 0

Smallpox at the Siege of Boston, November 1775–March 1776 | NEJM Smallpox played a pivotal role throughout the American Revolution, but the record remains ambiguous about whether British officers weaponized refugees to sow pestilence in the Continental Army.

When smallpox threatened the American Revolution, how did the Americans respond?

With inoculation :) #IDSky #vaccines

www.nejm.org/doi/full/10....

06.12.2025 14:01 — 👍 12 🔁 5 💬 0 📌 2

🆕🔥State of art review article by 🌟 s
@drtoddlee.bsky.social @steventong.bsky.social
Navigating the Challenges in Staphylococcus aureus Bloodstream Infection: A Practical Guide to Management #idsky #EMIMCC
www.sciencedirect.com/science/arti...

06.12.2025 12:34 — 👍 15 🔁 6 💬 4 📌 0

The ACIP decision to discontinue the recommendation for a universal hepatitis B birth dose vaccine will cause harm.

As the federal government continues to fail children's health, families can rely on our nation's physicians to continue to put children's health first.

05.12.2025 16:31 — 👍 122 🔁 79 💬 1 📌 1

Clinical impact of BioFire Blood Culture Identification 2 implementation in patients with Staphylococcus bacteremia | Microbiology Spectrum PCR-based blood culture testing with concurrent antimicrobial stewardship program review continues to facilitate the initiation of pathogen-targeted antimicrobials in a shorter amount of time compared...

🆕⚡🔥🧬 BCID2 on Fire — Slashing Vancomycin Time in Staph Bacteremia Faster ID , Safer Care, Microbiology Spectrum, 2025 #IDSky #EMIMCC
journals.asm.org/doi/10.1128/...

05.12.2025 20:20 — 👍 3 🔁 2 💬 0 📌 0

Seven-Day vs Four-Day Infusion Set Replacement Interval and Catheter-Related Infections Importance Catheter-related bloodstream infections (CRBSIs) are associated with longer hospital stays and increased mortality risks. The Replacement at Standard vs Prolonged Interval (RSVP) trial found that central venous access devices and peripheral arterial catheter infusion set replacement intervals can be extended from 4 to 7 days without increasing infection risk by more than 2%. However, the trial did not consider the full cost and health trade-offs of extending replacement intervals.Objective To estimate the changes in total cost and health benefits associated with a decision to adopt 7-day vs standard 4-day replacement intervals via decision-analytic modeling.Design, Setting, and Participants In this economic evaluation, a decision tree model was developed on August 26, 2025, from a health care perspective incorporating data from patients in the RSVP randomized clinical trial conducted from 2011 to 2016 across 10 Australian hospitals. Data were analyzed from December 12, 2016, to April 23, 2019.Main Outcomes and Measures A probabilistic sensitivity analysis generated a joint distribution of the expected change to cost and effectiveness outcomes. Parameter uncertainty was assessed, a cost effectiveness acceptability curve was plotted, and a value of information analysis was done.Results Of 2941 patients from the RSVP trial (median age, 59.0 years; range, 47-68 years), 62.9% were male. Of patients, 62.6% were admitted to intensive care, and common specialties were medical, hematology, and emergency surgical. A CRBSI risk of 1.78% in the 7-day group and 1.46% in the standard 4-day group was reported. The 7-day strategy was associated with annual savings of approximately 52 million Australian dollars (A$) (95% uncertainty interval [UI], −A$42 841 427 to A$181 823 300) from fewer set changes, offset by A$3.1 million (95% UI, −A$6 974 903 to A$14 099 754) in additional costs for treating CRBSI. The expected health outcomes were 395 (95% UI, −945 to 1739) additional infections, 103 (95% UI, −246 to 452) excess deaths, and 1724 (95% UI, −4199 to 7925) life-years lost at the population level. At a willingness-to-pay threshold of A$28 033, the probability that the 7-day strategy is cost-effective was 50.3%, and the probability that it is cost-saving was 82.67%.Conclusions and Relevance In this economic evaluation of the RSVP trial, a small increase in CRBSI risk was associated with large cost-savings and substantial health losses at the population level. While the RSVP trial assumed that a 2% equivalence margin was acceptable, the use of such arbitrary difference margins might not consider information that could change decision-making outcomes. The clinical and economic impacts of small increases to infections appear to be important for decision-making inference.

RSVP study: 7-day catheter change ⬇️cost by A$52M💰 but ↑CRBSI by 0.32% (1.78% vs 1.46%), causing ~103 excess deaths⚠️. 50.3% cost-effective, 82.7% cost-saving.

#idsky

04.12.2025 17:30 — 👍 1 🔁 1 💬 0 📌 0

Sounds like a temporary rift...but things need to change in the future or it will be likely to happen again due to problems with the methodology and execution

05.12.2025 03:32 — 👍 1 🔁 1 💬 0 📌 0

Would love to hear more about how you do this practically in your organization!

05.12.2025 03:32 — 👍 1 🔁 0 💬 1 📌 0

Teresa Karre, MD, associate professor in UNMC's Department of Pathology, Microbiology and Immunology and medical director of the Clinical Microbiology Laboratory

Dr. Teresa Karre, associate professor in our department and medical director of the Clinical Microbiology Lab at UNMC, talks with The Pathologist about the effort to detect drug-resistant infections:
tinyurl.com/3xuwavfy

03.12.2025 16:42 — 👍 3 🔁 2 💬 1 📌 0

Infectious Diseases Society of America (IDSA) Position Statement: Why IDSA Did Not Endorse the Community-Acquired Pneumonia Guidelines 2025 Update The Infectious Diseases Society of America (IDSA) did not endorse updated community-acquired pneumonia guidelines because they recommend antibiotics for pa

🆕⚡ A Temporary Rift or a Permanent Split? Why Didn’t IDSA Endorse the CAP Guidelines 2025 Update?
In 2025 IDSA disagreed because the new guidelines recommend routine antibiotics for viral-positive outpatients with comorbidities & inpatients with nonsevere CAP #IDSky
academic.oup.com/cid/article-...

04.12.2025 14:19 — 👍 5 🔁 3 💬 1 📌 0

🚨 >50% of ID fellowships went unfilled—just as the need is surging.

Currently on ID consults and seeing unprecedented volumes and an increasingly immunocompromised population at risk for life-threatening infections.

I’m worried we’re heading toward fewer specialists when we need them most.

04.12.2025 05:24 — 👍 31 🔁 13 💬 1 📌 1

Congratulations to the 272 physicians who matched into adult infectious diseases and the 44 who matched into pediatric infectious diseases this year. Over 50% of programs went unfilled, marking a very challenging match year for ID. The current hostile sentiment towards ID is not helping recruitment.

04.12.2025 13:35 — 👍 68 🔁 14 💬 3 📌 2

We Dissent: Lessons From the 2025 Community-Acquired Pneumonia (CAP) Guidelines Evidence to support antibacterial therapy for viral community-acquired pneumonia (CAP) is lacking. Shorter CAP treatment duration remains an important stre

We Dissent: Lessons From the 2025 Community-Acquired Pneumonia (CAP) Guidelines

IDSA withdrew from what was to be ATS/IDSA CAP guidelines b/c of impasse over the panel's recommendation to treat CAP with antibacterial therapy when a viral pathogen is identified.

academic.oup.com/cid/advance-...

04.12.2025 13:55 — 👍 12 🔁 3 💬 0 📌 1

Navigating the Challenges in Staphylococcus aureus Bloodstream Infection: A Practical Guide to Management

New article about how to manage Staphylococcus aureus bacteremia. Led by Hadar Mudrik-Zohar. Includes @seanong.bsky.social @drtoddlee.bsky.social
#IDSky #SNAP_trial

www.sciencedirect.com/science/arti...

04.12.2025 02:53 — 👍 14 🔁 5 💬 0 📌 0

Happy Match Day and welcome to all new ID fellows!!

For programs that have open spots, feel free to tag so we can repost!

03.12.2025 21:24 — 👍 15 🔁 5 💬 0 📌 0

Ahhhhhhhh!!!!!! Congrats, so happy for you!!

03.12.2025 21:22 — 👍 3 🔁 0 💬 1 📌 0

We are looking to add a pharmacy technician to our Nebraska Medicine OPAT team! Come help us provide extraordinary care for our patients!

Internal: wd5.myworkday.com/nebraskamed/...

External: nebraskamed.wd5.myworkdayjobs.com/NM/job/Omaha...

03.12.2025 20:38 — 👍 3 🔁 1 💬 0 📌 0

Breaking down the Desirability of Outcome Ranking (DOOR): unpacking the methodology behind the Dalbavancin as an Option for Treatment of Staphylococcus aureus Bacteremia (DOTS) trial Desirability of Outcome Ranking (DOOR) outcomes such as the primary outcome of the DOTS (Dalbavancin as an Option for Treatment of Staphylococcus aure…

🤔 I’ll admit — I’m still wrapping my head around DOOR in clinical trials. I’m used to P-values and classic non-inferiority, but DOOR feels different.
Breaking down the DOOR in DOTS RCT @cmicomms.bsky.social
#idsky #EMIMCC
www.sciencedirect.com/science/arti...

03.12.2025 20:57 — 👍 8 🔁 4 💬 0 📌 0

APIC and SHEA Announce Joint Healthcare Infection Prevention Advisory Group (HIPAG) - APIC

HICPAC is gone, but glad to see @apic-association.bsky.social and @sheaepi.bsky.social lead the way with this new advisory group

#IDSky
apic.org/news/apic-an...

03.12.2025 15:03 — 👍 8 🔁 3 💬 1 📌 0

A patient-centric paradigm and tool for clinical research: the DOOR is open ABSTRACTRandomized clinical trials are the gold standard for evaluating the benefits and harms of interventions and yet may not provide the evidence needed to inform medical decision-making, an ultimate goal for clinical research. Commonly used design and analysis approaches are often not suited to answer the most important questions to inform clinical practice, specifically how do resulting patient experiences, when comprehensively considering benefits and harms, compare between therapeutic alternatives? The standard approach of siloed analysis of one outcome at a time: (i) does not incorporate associations between multiple outcomes; (ii) does not recognize the cumulative nature of multiple outcomes in individual patients or recognize important gradations of global patient response; (iii) suffers from competing risk complexities during interpretation of individual outcomes; (iv) provides for ambiguous generalizability with respect to benefit:risk since efficacy and safety analyses are often conducted on different populations. Evaluation of treatment effect heterogeneity to identify subgroups for treatment or avoidance of treatment is typically evaluated based on a single efficacy or safety endpoint and rarely evaluated based on the overall benefit:risk. Methods that quantify and compare the patient experience are needed. The desirability of outcome ranking (DOOR) is a paradigm for the design, monitoring, analysis, interpretation, and reporting of clinical trials and other research studies based on patient-centric benefit:risk evaluation, developed to address these issues and advance clinical trial science. Aligning the clinical research strategy with the relevant question for clinical practice will enhance research applicability. Careful design and comprehensive analyses are critical for DOOR paradigm application. We provide a recommended statistical analysis plan for research studies implementing DOOR, describe its elements, and illustrate analysis application using examples. A freely available online tool for the recommended analyses and the design of studies implementing the DOOR paradigm is provided.ClinicalTrials.gov ID: NCT05641298

Trials often analyze outcomes separately, missing full patient experience. DOOR ranks outcomes 🔄 to assess overall benefit-risk, improving decision-making. Tool provided.

#idsky

03.12.2025 03:30 — 👍 1 🔁 1 💬 0 📌 0

It's very concerning that the ACIP may vote to delay hepatitis B virus (HBV) vaccines for children, as reported by
@reuters.com

Here's why. 🧵
www.reuters.com/legal/litiga...

02.12.2025 20:32 — 👍 170 🔁 78 💬 6 📌 15

Musculoskeletal Infections Tune into the Clinics Review Articles Podcast as we discuss the September 2025 issue of Infectious Disease Clinics, focusing on musculoskeletal infections. Hosted by consulting editor Helen W. Boucher...

🚨New podcast 🎙️ out from ID Clinics!

So fun to discuss #MSK 🦴 infxn mgmt with my brilliant colleagues & friends Drs. Laura Certain & Helen Boucher.

Also, check out the review articles in the journal’s Sept 2025 issue 🙂

🎧🔗: www.id.theclinics.com/audio-do/mus...

#MSKIDsky #IDsky #AMSsky

02.12.2025 22:41 — 👍 3 🔁 1 💬 0 📌 0

Jonathan Ryder, MD

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