Development of a Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to Guide Empiric Antibiotic Treatment for Ventilator-associated Pneumonia in a Mexican Tertiary Care University Hospital

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2025 Mar 4

PMID 40038606

Authors

Jaime Briseno-Ramirez

Adolfo Gomez-Quiroz

Brenda Berenice Avila-Cardenas

Judith Carolina De Arcos-Jimenez

Leonardo Perales-Guerrero

Jaime F Andrade-Villanueva

Pedro Martinez-Ayala

Affiliations

Soon will be listed here.

Abstract

Background: Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in critically ill patients, leading to high morbidity, mortality, and increased healthcare costs. The diversity of local microbiology and resistance patterns complicates the empirical treatment selection. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) offers an innovative tool to optimize empirical antibiotic therapy by integrating local microbiological data and resistance profiles.

Objective: To develop a WISCA tailored for VAP in a Mexican tertiary care university hospital, aiming to enhance empirical antibiotic coverage by addressing the unique pathogen distribution and resistance patterns within the institution.

Methods: This retrospective study included 197 VAP episodes from 129 patients admitted to a critical care unit between June 2021 and June 2024. Clinical and microbiological data, including pathogen susceptibility profiles, were analyzed using a Bayesian hierarchical model to evaluate the coverage of multiple antibiotic regimens. We also assessed the current impact of inappropriate empiric or directed treatment on in-hospital mortality using Cox regression models to support the development of a WISCA model.

Results: The median age of the patients was 44 years (IQR 35-56), with Acinetobacter baumannii (n = 71), Enterobacterales (n = 53) and Pseudomonas aeruginosa (n = 36) identified as the most frequently isolated pathogens. The developed WISCA models showed variable coverage based on antibiotic regimens and the duration of invasive mechanical ventilation (IMV). Inappropriate directed therapy during the VAP episode was associated with increased mortality, as were the diagnosis of Acute Respiratory Distress Syndrome (ARDS) and a high Sequential Organ Failure Assessment (SOFA) score (p < 0.01).

Conclusions: The tailored WISCA with Bayesian hierarchical modeling provided more adaptive, subgroup-specific estimates and managed uncertainty better compared to fixed models. The implementation of this WISCA model demonstrated potential to optimize antibiotic strategies and improve clinical outcomes in critically ill patients in our hospital.

Topic: Optimizing Empirical Antibiotic Therapy for Ventilator-Associated Pneumonia Using a Weighted-Incidence Syndromic Combination Antibiogram in a Mexican Tertiary Care Hospital.

References

Kollef M, Hamilton C, Ernst F . Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012; 33(3):250-6. DOI: 10.1086/664049. View

. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. DOI: 10.1164/rccm.200405-644ST. View

Yohannes S, Ahmed Z, Schelling R, Perinkulam Sathyanarayanan S, Pratt A, Schreiber M . Incidence and Impact of Ventilator Associated Multidrug Resistant Pneumonia in Patients with SARS-COV2. Crit Care Res Pract. 2022; 2022:9730895. PMC: 9463029. DOI: 10.1155/2022/9730895. View

Hay S, Rao P, Dolecek C, Day N, Stergachis A, Lopez A . Measuring and mapping the global burden of antimicrobial resistance. BMC Med. 2018; 16(1):78. PMC: 5985573. DOI: 10.1186/s12916-018-1073-z. View

Bai X, Jiang D, Yan S . High-Dose Tigecycline in Elderly Patients with Pneumonia Due to Multidrug-Resistant in Intensive Care Unit. Infect Drug Resist. 2020; 13:1447-1454. PMC: 7244348. DOI: 10.2147/IDR.S249352. View

Prestinaci F, Pezzotti P, Pantosti A . Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015; 109(7):309-18. PMC: 4768623. DOI: 10.1179/2047773215Y.0000000030. View

Barbieri E, Bottigliengo D, Tellini M, Minotti C, Marchiori M, Cavicchioli P . Development of a Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to guide the choice of the empiric antibiotic treatment for urinary tract infection in paediatric patients: a Bayesian approach. Antimicrob Resist Infect Control. 2021; 10(1):74. PMC: 8088309. DOI: 10.1186/s13756-021-00939-2. View

Zha L, Pan L, Guo J, French N, Villanueva E, Tefsen B . Effectiveness and Safety of High Dose Tigecycline for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis. Adv Ther. 2020; 37(3):1049-1064. PMC: 7223407. DOI: 10.1007/s12325-020-01235-y. View

Safdar N, Dezfulian C, Collard H, Saint S . Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005; 33(10):2184-93. DOI: 10.1097/01.ccm.0000181731.53912.d9. View

10.

Li Y, Liu C, Xiao W, Song T, Wang S . Incidence, Risk Factors, and Outcomes of Ventilator-Associated Pneumonia in Traumatic Brain Injury: A Meta-analysis. Neurocrit Care. 2019; 32(1):272-285. PMC: 7223912. DOI: 10.1007/s12028-019-00773-w. View

11.

Kalil A, Metersky M, Klompas M, Muscedere J, Sweeney D, Palmer L . Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016; 63(5):e61-e111. PMC: 4981759. DOI: 10.1093/cid/ciw353. View

12.

Hugonnet S, Eggimann P, Borst F, Maricot P, Chevrolet J, Pittet D . Impact of ventilator-associated pneumonia on resource utilization and patient outcome. Infect Control Hosp Epidemiol. 2005; 25(12):1090-6. DOI: 10.1086/502349. View

13.

Lim S, Zainal Abidin A, Liew S, Roberts J, Sime F . The global prevalence of multidrug-resistance among Acinetobacter baumannii causing hospital-acquired and ventilator-associated pneumonia and its associated mortality: A systematic review and meta-analysis. J Infect. 2019; 79(6):593-600. DOI: 10.1016/j.jinf.2019.09.012. View

14.

Rosenthal V, Maki D, Salomao R, Alvarez Moreno C, Mehta Y, Higuera F . Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med. 2006; 145(8):582-91. DOI: 10.7326/0003-4819-145-8-200610170-00007. View

15.

Chittawatanarat K, Jaipakdee W, Chotirosniramit N, Chandacham K, Jirapongcharoenlap T . Microbiology, resistance patterns, and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit. Infect Drug Resist. 2014; 7:203-10. PMC: 4140702. DOI: 10.2147/IDR.S67267. View

16.

Ayobami O, Brinkwirth S, Eckmanns T, Markwart R . Antibiotic resistance in hospital-acquired ESKAPE-E infections in low- and lower-middle-income countries: a systematic review and meta-analysis. Emerg Microbes Infect. 2022; 11(1):443-451. PMC: 8820817. DOI: 10.1080/22221751.2022.2030196. View

17.

Ramsamy Y, Muckart D, Bruce J, Hardcastle T, Han K, Mlisana K . Empirical antimicrobial therapy for probable v. directed therapy for possible ventilator-associated pneumonia in critically injured patients. S Afr Med J. 2016; 106(2):196-200. DOI: 10.7196/SAMJ.2016.v106i2.9870. View

18.

Curcio D, Castagnino J, Vazquez W, Vergara G, Curiale A . Tigecycline in the treatment of ventilator-associated pneumonia: experience from the Latin American Tigecycline Use Registry. Infez Med. 2010; 18(1):27-34. View

19.

Fowler R, Flavin K, Barr J, Weinacker A, Parsonnet J, Gould M . Variability in antibiotic prescribing patterns and outcomes in patients with clinically suspected ventilator-associated pneumonia. Chest. 2003; 123(3):835-44. DOI: 10.1378/chest.123.3.835. View

20.

Randhawa V, Sarwar S, Walker S, Elligsen M, Palmay L, Daneman N . Weighted-incidence syndromic combination antibiograms to guide empiric treatment of critical care infections: a retrospective cohort study. Crit Care. 2014; 18(3):R112. PMC: 4075242. DOI: 10.1186/cc13901. View