ArticleBMC infectious diseases2025
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.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Beyond the Cumulative Antibiogram: A Weighted-Incidence Syndromic Combination Antibiogram to Guide Empirical Therapy of Bloodstream Infections in the Emergency Department.Infectious diseases and therapy · 2026Article
- In-Hospital Mortality Predictors and a Bayesian Weighted-Incidence Antibiogram in Infective Endocarditis: A Seven-Year Cohort Study from a Mexican Tertiary University Hospital.Medical sciences (Basel, Switzerland) · 2026Article
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7 authors.
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Abstract
backgroundVentilator-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.
objectiveTo 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.
methodsThis 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.
resultsThe 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).
conclusionsThe 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.
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