paul evan bunce, md

i actually ordered a few of the puswhisperer paperbacks after making the episode. a token payback for all of the free insights and takeaways over the years.

thanks, jonathan. that's very kind of you.

mark crislip really set the template for a lot of us, so i’m flattered by the comparison. i'd be happy to say it's inspired by him and leave it there.

some of my favourite pearls from mark crislip include:

“piperacillin–tazobactam is the decerebrate antibiotic of choice”

“the plural of anecdote is anecdotes, not data”

mark’s impact was felt by many within and beyond the field of ID. here is a small glimpse of part of that legacy.

I know you’ll understand “Oh, when I saw that I was getting a colonoscopy, I just assumed you’d be a man. I’m so glad to see a woman is going to be doing my procedure today. I just feel more comfortable around female doctors....

I know you’ll understand:
A transgender woman physician reflects on her encounters with female patients
➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251220

thank you for the recommendation.

i really appreciated the window into the late 1980s HIV epidemic and the lives shaped by it.

i would encourage others to read it as well.

i appreciate the value of a Bayesian approach, but i can’t help feeling that a slight absolute difference being promoted as ‘most likely superior’ is like saying, "our expected runs/goals in that game was higher than the other team, so even though it was a tie, we really won."

Antimicrobial stewardship during extracorporeal membrane oxygenation: challenges and new perspectives Extracorporeal membrane oxygenation (ECMO) has emerged as a crucial modality in managing severe cardiac and respiratory failure; however, nosocomial infections and complex antimicrobial prescribing ch...

Important review of stewardship in ECMO

#IDSky

🔑 points:
-ID should be part of multi-disciplinary team
-More interventions not associated with 👍 outcomes
-Lots of gaps in 📚

Thanks to @mirandapharmdmph.bsky.social and team for writing!

www.clinicalmicrobiologyandinfection.org/article/S119...

i've found that it's often the smartest clinicians who tend to ask for input on tough cases

i try to do the same (in my head or directly), thinking who to ask and how they’d approach the case.

WWJD? episode 22 of the host response is up.

#idsky #meded #medsky

my sense is that there is a perception (right or wrong) that some authors have informal channels or prior access to editors.

i wonder if that perception itself is part of what drives presubmission emails?

should doxy+levo be the default for culture-negative PJI (if no contraindications)?

i’ve been leaning this way for a while (ever since Manreet presented the prelim data at city-wide rounds in 2024).

great to see this work published. #IDSky #PJI

Narrative review: diseases that masquerade as infectious cellulitis - PubMed For cellulitis that does not respond to conventional antimicrobial treatment, clinicians should consider, among other explanations, several noninfectious disorders that might masquerade as infectious cellulitis. Diseases that commonly masquerade as this condition include thrombophlebitis, contact de …

nice thread!

while this reference is a little dated, it's also a great review on the topic.

pubmed.ncbi.nlm.nih.gov/15630108/

Case 14. “AIDS Is Not My Worst Problem”: Caring for Women with HIV Podcast Episode · Viremic – Cases in HIV · 01/20/2026 · 39m

this recent Viremic podcast on the management of pregnant people living with hiv was outstanding.

the discussion was full of important pearls and concepts, and was shared with such humanity and empathy.

credit to the show host and guest, dr. jean anderson.

#idksy

i'll tell you a secret...

when i review cases remotely, i often look at the imaging before i go to the micro.

🤐

i love these (and this approach).

i also make a point on day 1 (and often day 2, 3, 4…) about the importance of reviewing radiology images directly, rather than relying solely on the report, especially ct scans and plain films.

I highly recommend @patrickching.bsky.social latest commentary in @ashejournal.bsky.social describing:

-the history of contact precautions
-the need for balance ⚖️ between the benefits of gowns/gloves with their cost/environmental impact

www.cambridge.org/core/journal...

#IDSky

interestingly, this review actually questions the value of adding gent for lactobacillus IE (as many question the value of synergistic AG's in other forms of IE).

direct quote from article: "...it would be tempting to state that aminoglycosides are not necessary in the treatment of this disease."

hypothetical: drained MSSA limb pyomyositis, not bacteremic

cefazolin is the easy choice, but if cure above all else is the priority, would anyone use another agent or strategy?

#idsky

Communicable | Communicable Episode 45: Top infectious diseases papers in 2025 In this episode of Communicable, Josh Davis (Newcastle, Australia) and Emily McDonald (Montreal, Canada), plus invited guest, Steven Tong (Melbourne, Australia)—all practicing physicians and clinical trialists— assemble to discuss some of their ‘top infectious diseases papers published in 2025’....

🎙️ Just published Communicable E45: Top infectious diseases papers in 2025

Hosted by Josh Davis & Emily McDonald w/ invited guest Steven Tong

Listen on #Communicable: https://share.transistor.fm/s/9e626f2a

#IDSky #clinmicro

check out our biggest bundle yet, same low price!

highlights include:
• sunnybrook hospital’s ASP website (excellent!)
• tstin3d (so helpful!)
• another “communicable” pearl - @cmicomms.bsky.social
• updated cUTI guidelines - adding clarity to the murkiness

plus, 2 non-id reads worth your time.

Gimme a Break! S4E06 Who Dunnit YouTube video by Gimme a Break

from the "medical knowledge i first learned from 80's sitcoms" files:

my first knowledge of CPR was from "gimme a break", where ray parker jr (ghostbusters!) made a guest appearance.

(start at 3:00 for the CPR scene)

the fashion remains timeless...the CPR, much more outdated.

job posting - infectious diseases clinician teacher position at st. mike's hospital in toronto

top notch hospital, amazing ID colleagues, diverse patient population, world class city

share broadly and apply if interested. it's a great opportunity.

jobs.utoronto.ca/job/Toronto-...

#idsky #idjobs

yes, this is the post i share the most with trainees.

followed by, "ID Learning Unit: Clinically Important Streptococcal Infections You Need to Know"

honourable mention to "The Curious Case of M184V" posts

ICYMI:

The latest episode of The Host Response.

The downside of doing the right thing in ID, either by draining the abscess or hitting the bacteria where it hurts.

Also, a nod to those on call at night when the crash often occurs...it’s tough work, but it doesn’t go unnoticed.

#idsky

Low-Dose TMP-SMX in the Treatment of Pneumocystis jirovecii Pneumonia: A Systematic Review and Meta-analysis Pneumocystis jirovecii pneumonia (PJP) remains a common and highly morbid infection for immunocompromised patients. Trimethoprim-sulfamethoxazole (TMP-SMX) is the antimicrobial treatment of choice. However, treatment with TMP-SMX can lead to ...

while those who managed PLWHIV with PJP in the 90’s often scoff at this, i suspect there is a large portion of pts who would do just as well with lower dose tmp-max than traditionally recommended.

pmc.ncbi.nlm.nih.gov/articles/PMC...

i really enjoyed this episode.

even trying to stay current, i’d missed all of these papers (oops). i appreciated such a clear, useful review.

with episodes this consistently good, communicable has entered my regular podcast rotation.

i just saw that app's for the 2026 ID Digital Institute (IDDI) are open.

this is an excellent program covering a range of digital media skills.

as part of the 2025 cohort, i can’t recommend it enough for anyone interested in digital education.

febrilepodcast.com/iddigitalins...

#idsky

who’d have thought that killing bacteria or draining an abscess might briefly make a patient worse?

turns out, smashing pathogens into inflammatory confetti has consequences.

that transient crash doesn’t always mean failure.
sometimes it means success.

🎙️ The Host Response, Ep 019

you could be fit enough to run a marathon…but 2 flights of stairs will make anyone speak in 2 word sentences and look like they’re about to keel over

(that’s my excuse, at least)

Congratulations to the indefatigable microbiologist Dr. Allison McGeer on her appointment to the #OrderofCanada. From SARS to flu to COVID and antimicrobial resistance, she is advancing science through her research, and promoting scientific literacy with her media appearances.

i’ve said it before, and i’ll say it again:

beware the afebrile patient with Staphylococcus aureus bacteremia.

#idsky