ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Clinical Infectious Diseases
Prior Culture-Guided Prediction of Antibiotic Susceptibility in Recurrent Respiratory Tract Infections: A Retrospective Cohort Analysis
Provisionally accepted
- 1Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- 2Department of Clinical Laboratory, Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China
- 3Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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ABSTRACT Background Recurrent respiratory tract infections (RRTIs) are a serious problem in older adults, necessitating appropriate early empiric antibiotic therapy. However, rising antimicrobial resistance complicates empiric treatment selection. Although prior culture results can offer guidance for empiric decisions, little data exist to quantify their predictive value in RRTIs. Therefore, we constructed a respiratory antibiogram and assessed Bayesian metrics of prior gram-negative isolates for predicting subsequent resistance or susceptibility in this population. Method A retrospective cohort included hospitalized RRTI patients (defined as RTIs occurring ≥2 times in 6 months or ≥3 times in 12 months). Patient-specific antibiograms were constructed. A Bayesian prevalence-calibrated estimation was used to assess the predictive validity of prior respiratory cultures for subsequent antimicrobial susceptibility in paired isolates. Sensitivity (Sen), specificity (Spec), Bayesian positive predictive value (PPV), negative predictive value (NPV), and resistance prevalence were calculated for 24 antibiotics, with bootstrap 95% confidence intervals. Analyses were restricted to bacterial pathogens. Result We included 463 visits from 160 unique patients, with a median age of 70. Pathogen distribution revealed Gram-negative bacteria (89.50%) and Gram-positive bacteria (10.50%). Antibiogram results showed that Pseudomonas aeruginosa exhibited >30% resistance to 10 antibiotics, while Klebsiella pneumoniae exhibited >35% resistance to 16 antibiotics. Prior cultures had good predictive value (>70%) for detecting future resistance to 22 antibiotics, with ciprofloxacin, levofloxacin, cefuroxime, cefotaxime, ampicillin, ampicillin/sulbactam, and ceftriaxone showing excellent predictive values (≥85%). Additionally, prior cultures had excellent predictive value (≥85%) for detecting future susceptibility to imipenem, amikacin, tobramycin, meropenem, minocycline, and tigecycline. Conclusion Considerable antibiotic resistance was detected among isolates in patients with RRTIs. Using a prior culture as a guide can enhance the probability of selecting an effective empirical agent.
Keywords: Respiratory Tract Infections, Recurrence, Antibiogram, antibiotic resistance, Bayesian prediction
Received: 30 Sep 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Li, Zhang, Ma, Gao, YUAN and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
WEIAN YUAN
Min He
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