Antimicrobial Use in Acute Myocardial Infarction-Related Cardiogenic Shock

Antimicrobial use (AMU) in acute myocardial infarction-related cardiogenic shock is common, but its prevalence, drivers, and outcomes are not well described.

We analyzed 1095 patients with acute myocardial infarction-related cardiogenic shock from the multicenter Northwell-Shock Registry (2016-2022). Patients undergoing coronary artery bypass surgery were excluded. AMU was defined as ≥24 hours of continuous therapy. Clinical features and outcomes were compared between AMU+ and AMU- groups.

Antimicrobials were used in 55% of patients, and 70% of them were initiated within 48 hours of admission. Positivity was low in AMU+ cultures (12.6% blood, 20.4% urine), and resistant organisms were found in only 9.5% of positive blood cultures. In 70% of patients, AMU was prolonged despite negative cultures. Broad-spectrum agents were used in 84.9%. Anti-methicillin-resistant Staphylococcus aureus and antipseudomonal agents were used in >70% of patients with AMU. While length of stay was longer in AMU+ patients (11 versus 4 days, P<0.01), the overall mortality rate was similar (35.2% versus 37.2%, P=0.485).

More than half of patients with acute myocardial infarction-related cardiogenic shock received antimicrobials. Most patients received broad-spectrum coverage despite low microbial culture yield and the rare isolation of resistant organisms. These findings highlight the need for targeted stewardship strategies to optimize AMU in acute myocardial infarction-related cardiogenic shock.