Healthcare-associated bloodstream infections (HA-BSIs) or sepsis are serious conditions often addressed via empiric combination antibiotic therapy (ECAT) – a methodology with inconsistent clinical practice and limited supporting evidence. A post hoc analysis was performed using data from the EUROBACT-2 international cohort study, including 2406 adult patients across 328 intensive care units (ICUs) in 52 countries, reflecting a broad application of ECAT in hospitals around the world.
Out of these patients, 75.2% received empiric antibiotic therapy, with ECAT applied in around half of the instances. The most commonly used antibiotic combination was beta-lactams and glycopeptides. Factors such as immunodeficiency, high Sequential Organ Failure Assessment (SOFA) scores, uncommon infection sources, and admission to ICUs with high rates of Enterobacteriaceae isolates producing carbapenemases were found to increase the likelihood of ECAT application.
However, despite the high prevalence of HA-BSIs in ICUs, the current practice and policies regarding ECAT usage are evidently varied due to multiple factors at individual, institutional, and national levels. Therefore, optimizing the usage of ECAT requires careful consideration of local antibiotic stewardship programs and specific patient needs.
Hospital-acquired infections, appearing more than 48 hours after hospitalization, are commonplace in ICUs, and a significant portion lead to critical conditions like sepsis, warranting urgent medical intervention. While ECAT has potential benefits, broad-spectrum antibiotics and multi-drug regimens come with possible risks, including adverse events, and could drive antibiotic resistance.
Furthermore, factors outside individual patient characteristics, such as geographic region, local traditions, resistance patterns, and institutional guidelines can influence antibiotic treatment practices. This underlines the importance of not only understanding the patient’s individual clinical picture but also navigating the wider medical, institutional, and cultural factors surrounding HA-BSI treatment.
This comprehensive analysis offers infection prevention professionals crucial insights into the current landscape of ECAT use, the factors influencing its adoption, and the potential implications it holds for patient outcomes. An overall strategic approach towards managing ECAT use would necessitate both a robust understanding of its clinical efficacy and a larger perspective of the sociocultural and institutional nuances that drive its application.