From respiratory cultures to empirical treatment: Integrating local resistance data, colonization risk, and patient-level factors in hospital-acquired pneumonia
- 1Department of Periodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
- 2Department of Infectious Disease, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
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.
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BibTeX
@article{razzaghi2026from,
title = {{From respiratory cultures to empirical treatment: Integrating local resistance data, colonization risk, and patient-level factors in hospital-acquired pneumonia}},
author = {Mahboobeh Razzaghi and Reza Razzaghi},
journal = {Journal of Preventive and Complementary Medicine},
year = {2026},
month = oct,
doi = {10.22034/jpcm.2026.590342.1388},
url = {https://doi.org/10.22034/jpcm.2026.590342.1388},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - From respiratory cultures to empirical treatment: Integrating local resistance data, colonization risk, and patient-level factors in hospital-acquired pneumonia
AU - Mahboobeh Razzaghi
AU - Reza Razzaghi
PY - 2026
DA - 2026/10/25
JO - Journal of Preventive and Complementary Medicine
DO - 10.22034/jpcm.2026.590342.1388
UR - https://doi.org/10.22034/jpcm.2026.590342.1388
AB - 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.
SN - 3041-9700
SN - 3041-9921
ER -