{
  "abstract": "Hospital-acquired pneumonia (HAP) remains a leading cause of nosocomial morbidity and mortality, particularly among mechanically ventilated and critically ill patients, and delays in adequate empirical antimicrobial coverage are independently associated with worsened outcomes. Because culture-based pathogen identification and susceptibility testing require time, clinicians must bridge the resulting uncertainty by integrating local epidemiological data with patient-specific risk assessment.This narrative review examines the interplay among respiratory culture results, local resistance data, colonization dynamics, and patient-level variables in shaping empirical therapy for HAP. Respiratory cultures from endotracheal aspirates or bronchoalveolar lavage remain the microbiological cornerstone of diagnosis and de-escalation, while emerging molecular diagnostics promise to shorten the empirical window. Cumulative antibiograms provide quantitative susceptibility estimates but report organism–drug pairs rather than syndrome-level coverage; weighted-incidence syndromic combination antibiograms (WISCA) address this limitation by incorporating pathogen incidence and combination susceptibility, and have been validated in ventilator-associated pneumonia and other syndromes. Colonization with multidrug-resistant organisms, prior culture results, clinical frailty, and immunocompromised status further modify the probability of resistant pathogens. Inappropriate empirical therapy is consistently associated with excess mortality, whereas guideline-concordant, microbiologically appropriate treatment improves outcomes in multidrug-resistant infections. Robust decision algorithms require deliberate integration of epidemiological, microbiological, and clinical data streams, supported by standardized reporting and bias assessment. Resource-limited and high-resistance settings face amplified challenges, yet cost-effective microbiology services and locally adapted antibiograms remain feasible and essential. Sustained investment in laboratory capacity, clinician education, rapid diagnostics, WISCA adoption, and hospital-wide stewardship interventions offers the most practical pathway to narrowing the gap between respiratory culture results and timely, adequate empirical treatment while minimizing selective pressure for further resistance.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Periodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran",
    "Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Mahboobeh Razzaghi"
    },
    {
      "affs": [
        1
      ],
      "name": "Reza Razzaghi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1m5dxm2y4a785.bib",
  "cited_by": 0,
  "doi": "10.22034/jpcm.2026.590342.1388",
  "fulltext_url": null,
  "id": "1m5dxm2y4a785",
  "issns": [
    "3041-9700",
    "3041-9921"
  ],
  "landing_url": "https://doi.org/10.22034/jpcm.2026.590342.1388",
  "language": "en",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "R"
    ],
    [
      "openalex",
      "2706|Nosocomial Infections in ICU"
    ]
  ],
  "openalex": "W7223841388",
  "pdf_url": "https://www.jpcmed.com/article_245745_61f744f929b42f75e6f90dc37c31fd13.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-25",
  "publisher": "Sadra Danesh Negar",
  "ris": "https://research.draconitic.com/paper/1m5dxm2y4a785.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:45:22Z",
      "native_id": "e1a7e2e6201845509853b2607b477878",
      "source": "doaj",
      "url": "https://doi.org/10.22034/jpcm.2026.590342.1388"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2706|Nosocomial Infections in ICU",
      "subfield": "general"
    }
  ],
  "title": "From respiratory cultures to empirical treatment: Integrating local resistance data, colonization risk, and patient-level factors in hospital-acquired pneumonia",
  "title_text": "From respiratory cultures to empirical treatment: Integrating local resistance data, colonization risk, and patient-level factors in hospital-acquired pneumonia",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:45:22Z",
  "url": "https://research.draconitic.com/paper/1m5dxm2y4a785",
  "venue": "Journal of Preventive and Complementary Medicine",
  "versions": []
}