Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Determinants of empiric combination antibiotic therapy for hospital associated bloodstream infections in the intensive care unit

Kauzonas, Evaldas LU orcid ; Torisson, Gustav LU orcid ; Merlo, Juan LU orcid ; Perez, Raquel LU orcid ; Tabah, Alexis ; Buetti, Niccolò ; Ruckly, Stéphane ; Barbier, François ; Timsit, Jean François and Sjövall, Fredrik LU orcid (2025) In Scientific Reports 15(1).
Abstract

Empiric combination antibiotic therapy (ECAT) is commonly used to treat healthcare-associated bloodstream infections (HA-BSIs) and sepsis. However, the level of supporting evidence is low and clinical practice varies significantly. We conducted a post hoc analysis using the EUROBACT-2 international cohort study database, which contained data on 2406 adult patients from 328 intensive care units (ICUs) across 52 countries, collected between June 2019 and January 2021. The main outcome was the proportion of patients receiving ECAT for HA-BSIs. Patient and institutional factors influencing the use of ECAT were examined using Markov-Chain Monte Carlo estimation. Three quarters of patients (75.2%; n = 1810) received empiric antibiotic... (More)

Empiric combination antibiotic therapy (ECAT) is commonly used to treat healthcare-associated bloodstream infections (HA-BSIs) and sepsis. However, the level of supporting evidence is low and clinical practice varies significantly. We conducted a post hoc analysis using the EUROBACT-2 international cohort study database, which contained data on 2406 adult patients from 328 intensive care units (ICUs) across 52 countries, collected between June 2019 and January 2021. The main outcome was the proportion of patients receiving ECAT for HA-BSIs. Patient and institutional factors influencing the use of ECAT were examined using Markov-Chain Monte Carlo estimation. Three quarters of patients (75.2%; n = 1810) received empiric antibiotic therapy, with ECAT used in approximately half of cases (52.5%; n = 950). Most patients receiving ECAT (70.4%; n = 669) were treated with two antibiotics, beta-lactams plus glycopeptides being the most common combination (40.2%; n = 382). The odds of ECAT were increased by immune deficiency (OR 1.35 [95% CrI 1.03–1.75]), SOFA scores > 11 (OR 1.77 [95% CrI 1.28–2.46]), uncommon sources of infection (OR 1.63 [95% CrI 1.02–2.59]), and admission to ICUs where > 25% of Enterobacteriaceae isolates produce carbapenemases (OR 2.46 [95% CrI 1.37–4.41). The intra-class correlation coefficients at the ICU and country levels were 23.2% and 4.4%, respectively. In conclusion, factors at the individual, institutional, and national levels may affect the use of ECAT to treat HA-BSIs. Given the impact of institutional variables on the use of ECAT and the inconclusive evidence regarding its potential risks, it is of great importance that treatment is tailored based on local antibiotic stewardship programs and the needs of the individual patient.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bloodstream infection, Combination antibiotic therapy, Empiric antibiotic therapy, Nosocomial infection, Sepsis treatment
in
Scientific Reports
volume
15
issue
1
article number
36481
publisher
Nature Publishing Group
external identifiers
  • pmid:41116049
  • scopus:105019629277
ISSN
2045-2322
DOI
10.1038/s41598-025-22687-8
language
English
LU publication?
yes
id
ddc30ee6-7c96-45e5-8a52-2091a3a0eb0b
date added to LUP
2025-12-11 15:27:18
date last changed
2025-12-11 15:28:37
@article{ddc30ee6-7c96-45e5-8a52-2091a3a0eb0b,
  abstract     = {{<p>Empiric combination antibiotic therapy (ECAT) is commonly used to treat healthcare-associated bloodstream infections (HA-BSIs) and sepsis. However, the level of supporting evidence is low and clinical practice varies significantly. We conducted a post hoc analysis using the EUROBACT-2 international cohort study database, which contained data on 2406 adult patients from 328 intensive care units (ICUs) across 52 countries, collected between June 2019 and January 2021. The main outcome was the proportion of patients receiving ECAT for HA-BSIs. Patient and institutional factors influencing the use of ECAT were examined using Markov-Chain Monte Carlo estimation. Three quarters of patients (75.2%; n = 1810) received empiric antibiotic therapy, with ECAT used in approximately half of cases (52.5%; n = 950). Most patients receiving ECAT (70.4%; n = 669) were treated with two antibiotics, beta-lactams plus glycopeptides being the most common combination (40.2%; n = 382). The odds of ECAT were increased by immune deficiency (OR 1.35 [95% CrI 1.03–1.75]), SOFA scores &gt; 11 (OR 1.77 [95% CrI 1.28–2.46]), uncommon sources of infection (OR 1.63 [95% CrI 1.02–2.59]), and admission to ICUs where &gt; 25% of Enterobacteriaceae isolates produce carbapenemases (OR 2.46 [95% CrI 1.37–4.41). The intra-class correlation coefficients at the ICU and country levels were 23.2% and 4.4%, respectively. In conclusion, factors at the individual, institutional, and national levels may affect the use of ECAT to treat HA-BSIs. Given the impact of institutional variables on the use of ECAT and the inconclusive evidence regarding its potential risks, it is of great importance that treatment is tailored based on local antibiotic stewardship programs and the needs of the individual patient.</p>}},
  author       = {{Kauzonas, Evaldas and Torisson, Gustav and Merlo, Juan and Perez, Raquel and Tabah, Alexis and Buetti, Niccolò and Ruckly, Stéphane and Barbier, François and Timsit, Jean François and Sjövall, Fredrik}},
  issn         = {{2045-2322}},
  keywords     = {{Bloodstream infection; Combination antibiotic therapy; Empiric antibiotic therapy; Nosocomial infection; Sepsis treatment}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Nature Publishing Group}},
  series       = {{Scientific Reports}},
  title        = {{Determinants of empiric combination antibiotic therapy for hospital associated bloodstream infections in the intensive care unit}},
  url          = {{http://dx.doi.org/10.1038/s41598-025-22687-8}},
  doi          = {{10.1038/s41598-025-22687-8}},
  volume       = {{15}},
  year         = {{2025}},
}