Improving empiric antibiotic prescribing in pediatric bloodstream infections: a potential application of weighted-incidence syndromic combination antibiograms (WISCA)

Estimating antibiotic coverage from linked microbiological and clinical data from the Swiss Paediatric Sepsis Study to support empiric antibiotic regimen selection

“…Weighted-incidence syndromic combination antibiograms (WISCA) were used to estimate coverage to the chosen empiric regimens. As previously described (11,12,17), the WISCA is conceptualised as a Bayesian decision tree approach accounting for relative incidence of causative pathogens producing a point estimate of coverage as the mean of the posteriors and a 95% credible interval for each regimen of interest. We used noninformative priors for relative incidence and susceptibility.…”

“…One approach that has been described and combines microbiological and clinical data is to calculate expected coverage of antibiotic regimens based on a weighted incidence syndromic combination antibiogram (WISCA) (10)(11)(12). Syndromic coverage estimates use routine microbiological data from patients with specific infections, for example children with bloodstream infections, to assess the probability that a specific regimen will cover episodes of that syndrome, improving clinical relevance.…”

Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the Pacific

“…In calculating susceptibility, assumptions as outlined above were incorporated, including those pertaining to the intrinsic resistance of organisms and susceptibility across antibiotic classes, when susceptibility testing was lacking (specified in Supplementary Table 2 ). 20 The models were fit using Hamiltonian Monte Carlo using 3 chains and 20,000 draws per chain for all models. Convergence was checked via traceplots and Gelman-Rubin (R-hat) statistics.…”

“… 16 , 18 , 19 WISCAs may be particularly helpful for informing the empirical treatment of sepsis and meningitis – where pathogen isolation may be difficult and the consequences of ineffective therapy are high – whilst also providing a tool for antibiotic stewardship, which is of importance in light of increasing global AMR. 1 , 5 , 15 , 20 …”