ArticleInfectious diseases and therapy2026
Beyond the Cumulative Antibiogram: A Weighted-Incidence Syndromic Combination Antibiogram to Guide Empirical Therapy of Bloodstream Infections in the Emergency Department.
Article in Infectious diseases and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionTraditional cumulative antimicrobial susceptibility test report (cAST) have limitations in supporting empiric antibiotic selection decisions. We evaluated the complementary roles of weighted-incidence syndromic combination antibiogram (WISCA) and the traditional cumulative antimicrobial susceptibility test report (cAST) in guiding empirical therapy for bloodstream infections (BSIs) in the emergency department (ED).
methodsWe performed a retrospective cohort study including all consecutive adult BSI episodes attended in the ED of a tertiary-care hospital in Barcelona, Spain (January 2022-December 2024). A hospital cumulative antimicrobial susceptibility test report (cAST) was generated according to standard methodology for pathogens with ≥30 bloodstream isolates. WISCA coverage was calculated for eight monotherapy and six combination empirical regimens by weighting in vitro susceptibility according to pathogen frequency. Coverage was further stratified by infection acquisition (community-acquired vs. healthcare-associated) and source of infection.
resultsA total of 1716 BSI episodes were analyzed (median age 78 years; 55.2% male); 69.4% were healthcare-associated and the main source was urinary tract infection (42%). The 1913 isolates recovered were predominantly Gram-negative (70.3%); ESBL-producing Enterobacterales accounted for 24.9% of Enterobacterales. The cAST covered 87.3% of isolates after species grouping, whereas WISCA incorporated all pathogens. Highest WISCA coverage among monotherapies was observed with imipenem (94.8%), meropenem (91.3%), and piperacillin/tazobactam (89.6%). Ceftriaxone coverage increased from 65.1% to 88.7% when combined with amikacin, whereas carbapenem-based combinations provided only limited additional coverage overall (meropenem plus amikacin, 92.8%; meropenem plus vancomycin, 97.6%). Coverage was consistently lower in healthcare-associated than in community-acquired BSIs, particularly for ceftriaxone, fluoroquinolones, and amoxicillin/clavulanic acid, and was highest in respiratory-source BSIs.
conclusionsWISCA complements the cAST by providing regimen-level, syndrome- and subgroup-specific coverage estimates, capturing pathogen diversity missed by species-threshold cAST reporting. Integrating WISCA into local antimicrobial-stewardship programs may refine empirical treatment choices for ED bacteremia, especially according to the BSI source and patient-specific characteristics, while supporting judicious use of broad-spectrum agents.
Indexed as
Identifiers
42786392What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.