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1rem

In our latest podcast, Tim Gauthier, PharmD, BCPS, BCIDP, discusses his passion for all things pathogens and antibiotics.  He also details the opportunities for antimicrobial stewardship when it combines diagnostics and treatment duration. 

A Passion for Infectious Disease Education and Communication

Tim Gauthier PharmD, BCPS, BCIDP, began his career in academia, and although he has transitioned to working in a health system he has never left behind his passion about education around pathogens, antibiotics, and stewardship. He has 2 websites, 

, on these topics and it has really allowed him to continue communicating and educating people globally on these infectious disease subjects.

“I love this stuff so much, genuinely. I have a website called ID Stewardship, and many people are familiar with my work and my reach through that avenue where it's been just super cool to connect with people from all over the world and help people learn about antibiotics,” Gauthier said.

This website has reached millions of people since he first launched it in 2016, and he says it has allowed him to talk about his experiences in the field.

“It's really geared towards practical, real-life experience, and suggestions about how to go about navigating something. It could be anything in the field of clinical pharmacy or infectious diseases, antimicrobial stewardship, or pharmacy education. And the goal really is to provide quick information that is useful and practical for the reader,” Gautier explained.

He reminds people that everyone learns differently and having resources such as websites can be helpful for young learners as they begin to digest the voluminous amounts of educational materials they need to commit to memory.

For years, Gauthier has been communicating with the masses through social media, especially using Twitter/X and built a large audience through it. “I think it's been pretty neat to provide education in that forum too,” Gauthier said.

He sees the changes in social media today and as many people in the infectious disease community have steered away from the Twitter/X platform, Gauthier still uses it and acknowledges how it has evolved.

“I've been a content creator for infectious diseases education material for almost a decade, and it just changes,” Gauthier said. “So, Instagram becomes more popular as Facebook pages become less popular, or TikTok gains traction, and then TikTok loses traction. It's always changing and it's always evolving. You always have to— in my mind at least—go back to why am I here? What is my purpose? What am I doing? And if what you're engaging in aligns with what your purpose is, then you're probably fine…I don't feel great about X. I go on my profile and I just see content that I'm not interested in. It's super toxic, and I don't feel good about being part of that community right now. I’m keeping an eye on it and trying to maybe have a voice to some degree, because if we don't have a voice, someone will be happy to speak for us.” 

He also mentions the importance of staying professional on these platforms, and he values the importance of taking the time to reach out whether it is remotely through digital means or connecting in person with professionals in the infectious disease field or other fields at institutions including the lab.

“Respect for all individuals is something that we need to keep front of mind as we go through these very turbulent times and consider using social media or not,” Gauthier said. “That's one of my biggest things…as I'm looking around, the other thing is, we can get a lot of happiness out of working together. I really do believe that, and we should not hesitate to reach out and make connections with each other. If you haven't talked to your ID pharmacist, or if you haven't spoken to your microbiology lab folks, just go visit them.” 

Although Gauthier is excited to see some new antibiotics get FDA approved, he does acknowledge they will not likely replace the older, more established “workhorse” antibiotics. Resistance is always a concern and he is seeing extended-spectrum beta-lactamases (ESBL) 

, where he lives. Nonetheless, he sees a stewardship opportunity in these situations that combines shorter courses of antibiotics with help from the laboratory.

“When we look at the latest CDC [Centers for Disease Control and Prevention] report that they had put out, ESBLs are on the upward trend. And, locally in the Miami area, many of the hospitals here have considerable rates of ESBL 

,” he explained. “And you know what comes next? You probably use more carbapenems. Okay, use more carbapenems. What happens? You get more carbapenem resistance. That is the major issue right now that I'm seeing. I think people need to be aware of managing asymptomatic bacteria appropriately, picking shorter courses of antibiotics, and when reasonable, deescalating and narrowing within 48 to 72 hours, utilizing and leveraging the data that's coming out of the lab to make those decisions faster and smarter.”

, and much like other areas, Gauthier is seeing this mostly in long-term care patients with chronic conditions and comorbidities.

“There's definitely more patients with bloodstream infections with 

 than I would have liked to have seen in my life. And of course, the drug resistance that comes with 

 is particularly concerning,” he said. “Although I would say that hospitals that have highly complex patients that have histories of solid organ transplant, for example, or many days and months in the ICU are probably going to be battling this much more.”



Disclaimer: "The views and opinions expressed represent those of the speaker and do not necessarily reflect the official position or policy of any previous, current, or potential future employer."

In our latest podcast, Tim Gauthier, PharmD, BCPS, BCIDP, discusses all things pathogens and antibiotics.  He also details the opportunities presented for antimicrobial stewardship when it combines diagnostics and treatment duration. 

A Passion for Infectious Disease Education and Communication 

A retrospective study finds no significant difference in treatment failure between obese and non-obese patients.

Impact of Obesity on Micafungin Treatment Outcomes in Candidemia

At ASM Microbe 2025, a Puerto Rico study links increased fungal spore concentrations to rises in viral respiratory infections, suggesting potential early warning utility.

Airborne Fungal Spores May Predict Short-Term Surges in COVID-19 and Influenza

At ASM Microbe 2025, a cross-sectional study highlights Burkholderia cepacia dominance, widespread antibiotic resistance, and key risk factors, including invasive device use and patient demographics.

Bloodstream Infections in Ethiopia Reveal High Rates of Multidrug Resistance and Fungal Involvement

New modeling estimates up to 360,000 symptomatic cases annually, 10 to 18 times higher than reported, with CDC experts calling for expanded testing, reporting, and clinical awareness.


CDC Estimates True Valley Fever Burden May Be Up to 18 Times Higher Than Reported

Q&A with Amy Cain discusses cannabidiol and cannabidivarin’s effects on fungal biofilms and drug-resistant strains.

Phytocannabinoids Demonstrate Fungicidal Activity and Inhibit Fungal Virulence Factors

New Antifungal Drug Olorofim Shows Promise in Treating Resistant Fungal Infections

A novel antifungal agent, olorofim, is demonstrating significant promise in treating life-threatening invasive fungal diseases (IFD), particularly in patients with few or no other treatment options. The therapy, developed by F2G, is the first in its class and has shown encouraging results in a phase 2b open-label trial, prompting discussion about its clinical utility, stewardship integration, and future risks.

John Rex, MD, FACP, chief medical officer at F2G, spoke with 

 to discuss the clinical challenges of fungal diagnostics and how olorofim may fit into the future of antifungal care.

“What challenges don’t remain would be a better version of that question,” Rex said when asked about the difficulty of diagnosing IFD early enough to intervene effectively. “Fungal infections are—in one sense—easy to diagnose when you biopsy a place where the fungus is. But in another sense, you don’t really want to do that; you’d actually like to have alternative ways to diagnose.”

He pointed to the limited number of serologic tests available, noting that for some of the most dangerous fungi, “those tests don’t always work all that well.” According to Rex, “sometimes it’s harder to think of the idea of a fungus than it is ultimately to diagnose it.”

The primary endpoint, a composite global response measured at day 42, was achieved in 28.7% of patients. By day 84, 27.2% had maintained that response. When stable disease was included in the definition of success, the numbers rose to 75.2% at day 42 and 63.4% at day 84. Clinical responses alone were seen in nearly 60% of patients by day 42.

The phase 2b trial enrolled 204 patients across 11 countries, with 203 receiving olorofim and 202 confirmed to have invasive fungal disease. Participants were infected with notoriously difficult pathogens including 

 (including 22 azole-resistant strains), 

. These organisms are often resistant to conventional antifungals, making the study population particularly high risk.

When asked how olorofim fits into antifungal stewardship and diagnostic pathways, Rex emphasized the drug’s specificity, “The thing to know about olorofim to start with is that it’s a special drug for special patients. You need to know what you’re treating if you’re going to use olorofim.”

He explained that olorofim targets dihydroorotate dehydrogenase (DHODH)—an enzyme critical to the pyrimidine biosynthesis pathway, but does so selectively in certain molds. “All of us have a version of this enzyme, but we don’t all have the same version. It just turns out that—for whatever reason—

 and all of its cousins… have almost the same enzyme.”

These include Lomentospora, Scedosporium, Rasamsonia, and the dimorphic fungi such as 

. By contrast, Rex noted that the enzyme versions in 

, bacteria, and parasites are markedly different—reinforcing the need for accurate fungal diagnosis before initiating therapy.

Treatment durations in the trial varied, with some patients receiving olorofim for up to a year, particularly for infections in hard-to-treat areas such as bone and brain. The drug was generally well tolerated, with 10% of patients experiencing liver enzyme elevations that resolved with dose adjustments or discontinuation. No treatment-related deaths were observed.

On the question of resistance, Rex was realistic but cautiously optimistic.“Like every antimicrobial ever invented, the organisms will one day figure out how to escape. It’s just the nature of the universe.”

Still, he noted that olorofim’s target enzyme is “remarkably well conserved” among Aspergillus-related species, and that resistance has not yet emerged in clinical use. “We say that basically, olorofim has a unimodal MIC distribution. There’s one peak. There’s not a second peak out in the distance at higher MICs.”

To date, the data—recently published from roughly 200 treated patients—shows no emergence of resistance during therapy, including among those enrolled in compassionate access programs. Rex expressed concern about potential agricultural use of olorofim, which could compromise its efficacy in humans. “There is interest in using olorofim to take care of diseases in wheat and other important grains… That’s something we all need to think really carefully about.”

He added that olorofim’s oral formulation also sets it apart, “It kills the fungus and it’s also a drug. It’s a pill. And that’s rare. It’s hard enough to find an antifungal—much less to find one that’s a pill you can actually take for months and months on end.”

With an average treatment duration of six to seven months in the trial, and some patients exceeding that, olorofim represents a potential new standard in the treatment of difficult, resistant IFDs. Although, phase 3 trials will be needed to solidify its role in broader clinical practice.

F2G, Ltd. F2G Announces Publication in The Lancet Infectious Diseases of Phase 2b Data Demonstrating Positive Therapeutic Responses in Patients with Serious Invasive Fungal Diseases Treated with Oral Olorofim. 

. Published June 26, 2025. Accessed June 26, 2025. 

https://www.globenewswire.com/news-release/2025/06/18/3101340/0/en/F2G-Announces-Publication-in-The-Lancet-Infectious-Diseases-of-Phase-2b-Data-Demonstrating-Positive-Therapeutic-Responses-in-Patients-with-Serious-Invasive-Fungal-Diseases-Treated-.html

Maertens JA, Thompson GR 3rd, Spec A, et al. Olorofim for the treatment of invasive fungal diseases in patients with few or no therapeutic options: a single-arm, open-label, phase 2b study. 

. Published online June 17, 2025. doi:10.1016/S1473-3099(25)00224-5

John Rex, MD, FACP, discusses the promise, precision, and challenges of this first-in-class antifungal following phase 2b trial results.

New Antifungal Drug Olorofim Shows Efficacy in Treating Resistant Fungal Infections

At the ASM Microbe conference, Mike Bromley, PhD, offers some insights on the importance of a One Health approach addressing the growing antifungal resistance to azoles and Aspergillus fumigatus because of the connection between crop spraying and the rise of resistance.

Considering the Impact of Crop Spraying and Antifungal Resistance

Earlier this year, the World Health Organization published its first-ever reports on therapies and diagnostics for fungal diseases. Fungal infections are increasing and the mortality rates can reach as high as 88% for fungi in the top ‘critical priority’ category of the WHO’s 

, more than 10 million people suffer from lung diseases caused by it.

 And what is especially concerning is first-line therapeutics for most of these infections, the class of antifungals, known as the azoles, are becoming more resistant.

Interestingly, there is a connection between what would seemingly be 2 different distinctive areas and how they relate to one another. According to the Centers for Disease Control and Prevention (CDC), the concept of One Health is, “an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment.” The federal agency writes the concept is not new but has become more relevant in recent years with the interactions between people, animals, plants, and our environment.

One example of this interaction and where it is demonstrating known effects is the spraying of fungicides on crops and antifungal resistance in people. Mike Bromley, PhD, professor of Medical Mycology at the University of Manchester and director of the Manchester Fungal Infection Group has been studying this area and says it is vital to be thinking about the One Health approach to this problem. He will be presenting on this topic at the ongoing ASM Microbe Conference this week.

“We have to think about the issues of One Health when we're thinking about antifungal resistance, and the reason for that is a lot of the resistance we see in the clinic is derived from the environment,” he said. “What's happening is that we're using really large amounts of the azole class of fungicides to treat plant pathogens of crops, and these azole fungicides are critically important for the protection of our crops, because without them, we wouldn't be able to generate enough food to sustain our populations. It's really important that the agricultural sector is able to use these fungicides, but the problem is that 

, which is one of the human pathogens, resides in the same areas as some of these plant pathogens. So when we spray crops with these azole fungicides, 

 is there too. And because it's there in environments where azoles are there in quite high concentrations, you see the emergence of resistance in the environment, and then people breathe in the spores of 

and become infected with resistant strains before they're ever treated.”

One particular area that is problematic is compost heaps, explains Bromley.

 loves to grow when it's really, really warm, and in these compost heaps, 

 thrives. Compost is basically taking all that waste biological  plant material that has often been sprayed with fungicides, and concentrating that in 1 location. So you're getting high levels of drugs and you're getting 

 growing very rapidly. So that's where resistance is emerging, and that's where we can make the biggest efforts in a One Health context to try and prevent the further emergence and spread of azole resistance in 

He says simply wetting compost heaps is one way to reduce 

Overall, in terms of looking at ways to combat resistance, Bromley says stewardship is a significant strategy.

“We're not necessarily talking about stewardship in the clinical sense. We're talking about stewardship in the environment—only using those antifungals or those fungicides when they're really needed in the environment, only spraying crops when they're needed, spraying at the right time, at the right concentrations, not overusing them in the environment,” Bromley said.






References
1. WHO issues its first-ever reports on tests and treatments for fungal infections. WHO press release. April 1, 2025. Accessed April 1, 2025.


https://www.who.int/news/item/01-04-2025-who-issues-its-first-ever-reports-on-tests-and-treatments-for-fungal-infections


2. van Rhijn N, Zhao C, Al-Furaiji N, et al. Functional analysis of the Aspergillus fumigatus kinome identifies a druggable DYRK kinase that regulates septal plugging [published correction appears in Nat Commun. 2024 Aug 20;15(1):7126. doi: 10.1038/s41467-024-50129-y.]. 

. 2024;15(1):4984. Published 2024 Jun 11. doi:10.1038/s41467-024-48592-8
3. About One Health. CDC. October 30, 2024. Accessed June 20, 2025.


https://www.cdc.gov/one-health/about/index.html


4. Antifungal drug resistance: A one health problem. Session AAR-IDS-201. Presented at ASM Microbe 2025. June 19-23, 2025. Los Angeles, CA.



At the ASM Microbe conference, Mike Bromley, PhD, offers some insights on the importance of a One Health approach addressing the growing antifungal resistance to azoles and Aspergillus fumigatus because of the connection between crop spraying and the rise of resistance.



Conferences

Jatin Vyas, PhD, MD, offers some insights into the economics of development, the biology of fungal species, and the difficulties behind creating new antifungal molecules.  

Deciphering Similarities and Differences in Development for Antifungals vs Antibiotics

Globally, more than 6.5 million people contract fungal infections annually, according to a systematic review published last year in 

There are 3.8 million deaths with about 2.5 million of them directly attributable to these infections.

The rise of these infections and consequently resistance can be contributed to factors such as the widespread use of fungicides in agriculture, climate change, fungal species’ ability to develop resistant mechanisms, and limited treatment development.

A major issue with treatment development has to do with the biology of fungal organisms, according to Jatin Vyas, PhD, MD professor of Medicine, Columbia University, associate dean for Academic Innovation, and director of Physician- Scientist Programs at the Vagelos Institute for Biomedical Research Education. He explains there are similarities between fungal organisms and mammal cells.

“Fungal organisms are eukaryotes, and what that means is they have an organized nucleus, and they resemble more mammalian cells than they do other types,” Vyas said. “And the reason that's important is because much of the machinery that is found in fungal organisms is very similar to the machinery that keeps our mammalian cells alive. So, whenever we can identify targets that will actually kill a fungal organism, those same drugs will have a significant effect on mammalian cells, leading to really terrible side effects, and oftentimes can't be used because of the toxicity.”

He explains that in developing antifungals, researchers are trying to find those select pathways that exist only in the fungal organisms, and that don't exist in the mammalian cells.

In thinking about antifungal and antibiotic development, Vyas sees 1 similar hurdle for both: economics. The way in which new antibiotics are prescribed demonstrates a likely path for new antifungals.

“Oftentimes, those drugs don't see a lot of use right up front, especially antibiotics,” Vyas said. "Infectious disease clinicians will restrict those because we want to maintain the efficacy of those types of drugs for a significant period of time. Therefore, the ability for pharmaceutical companies to be able to recoup their costs—which is significant for any type of drug development—[is challenging]. The business model isn't great when it comes to antibiotics; that is the same for antifungals.”

Vyas says whereas, there has been more research and development around bacterial infections and subsequently antibiotics, there is still limited knowledge associated with fungal organisms, which restricts antifungal development.

“We really do need to understand how these organisms actually cause disease, and what is the mechanism of that disease,” Vyas said.

“If you start with the first antifungal that was developed in this country and licensed by the FDA in 1956, and you go all the way up to now 2025, you can see that despite all those years and the development of newer antifungals, your chance of dying of an invasive fungal infection hasn't significantly changed with the development of these drugs. The drugs have become more well tolerated…but their efficacy hasn't actually improved over a significant period of time.”


References
1. Denning DW. Global incidence and mortality of severe fungal disease. 

. 2024;24(7):e428-e438. doi:10.1016/S1473-3099(23)00692-8
2.Combating Antifungal Resistance. ASM. November 30, 2022. Accessed June 15, 2025.
https://asm.org/articles/2022/november/combatting-antifungal-resistance

Deciphering Similarities and Differences in Antifungal and Antibiotic Development 

Joshua A Hill, MD, FIDSA  highlights efforts to starts a national clinical trials network to address gaps in research for immunocompromised patients and improve patient care.

Joshua A Hill, MD, FIDSA, an infectious disease specialist at Fred Hutchinson Cancer Center and the University of Washington Medical Center, is focused on improving care for immunocompromised patients who face risks from infections and are often excluded from clinical research.

“Our patient population that we treat here in Seattle at our academic medical centers and our large, complex medical systems here are getting increasingly immune compromised,” Hill said. “I think we're seeing more drugs that are available to treat a variety of different conditions, to target the immune system to treat these conditions, and also our survivorship is increasing, so we're keeping patients healthier for longer, but at the expense of sometimes having medications that are impacting immune function.”

Patients with weakened immune systems are at increased risk for infections, including viral, bacterial, and fungal infections, as well as emerging infectious diseases.

“We're seeing a lot of emerging infectious diseases as the epidemiology shifts here. So I think there's a lot of challenges as we move forward in helping to protect this vulnerable sector of society and really learning how to best support them with new medical advances like new types of vaccines, new vaccine platforms, and new therapies like cellular therapy.”

One challenge Hill highlights is the exclusion of immunocompromised individuals from clinical trials, which limits the development of evidence-based guidelines for these high-risk patients.

“One of the problems, I would say, that we've seen over the past five to ten years—and then really, if you expand beyond the COVID era—is that these highly immunocompromised patient populations are oftentimes excluded from clinical trials, which really focus on healthier general population groups of individuals,” Hill said. “Sometimes the immune compromised patients are those that we need to study the most carefully, because they are sometimes at the most risk for the infection or worse outcomes from infectious diseases, and may respond differently to treatments and may need different types of approaches than a healthy individual.”

Building a National Clinical Trials Network

To address this issue, Hill and his colleagues are working to create a 

 dedicated to immunocompromised patients. The network aims to bring together institutions, investigators, and healthcare providers to collaborate on research for this patient group.

“To try to reduce some of the barriers to implementing and conducting these clinical trials, we're working on an initiative to build a National Clinical Trials Network that includes the institutions and the investigators and the healthcare providers that really have expertise in this space,” Hill explained. “We can more readily recruit patients and come together to think about what the high priority areas are, what new types of therapies we have at our disposal, and how we can best design trials to address some of the big questions.”

As therapies that impact the immune system become more common, patients are living longer but with increased susceptibility to infections, including viral, bacterial, fungal, and emerging diseases.

Fungal Infections

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