Journal Article

Comparison of Empiric Antibiotic Treatment Regimens for Hospitalized, Non-severe Community-acquired Pneumonia: A Retrospective, Multicenter Cohort Study

Juang, Paul A., Hartmann, Aaron P., Reeves, Sidney D., Micek, Scott T., Hofer, Mikaela, Betthauser, Kevin D., Tedder, Amanda C., Kollef, Marin H.

2024

Overview

Consensus guidelines for hospitalized, non-severe community-acquired pneumonia (CAP) recommend empiric macrolide + β-lactam or respiratory fluoroquinolone monotherapy in patients with no risk factors for resistant organisms. In patients with allergies or contraindications, doxycycline + β-lactam is a recommended alternative. The purpose of this study was to compare differences in outcomes among guideline-recommended regimens in this population. This retrospective, multicenter cohort study included patients ≥18 years of age with CAP who received respiratory fluoroquinolone monotherapy, empiric macrolide + β-lactam, or doxycycline + β-lactam. Major exclusion criteria included patients with immunocompromising conditions, requiring vasopressors or invasive mechanical ventilation within 48 hours of admission, and receiving less than 2 days of total antibiotic therapy. The primary outcome was in-hospital mortality. Secondary outcomes included clinical failure, 14- and 30-day hospital readmission, and hospital length of stay. Safety outcomes included incidence of new Clostridioides difficile infection and aortic aneurysm ruptures. Of 4685 included patients, 1722 patients received empiric respiratory fluoroquinolone monotherapy, 159 received empiric doxycycline + β-lactam, and 2804 received empiric macrolide + β-lactam. Incidence of in-hospital mortality was not observed to be significantly different among empiric regimens (doxycycline + β-lactam group: 1.9% vs macrolide + β-lactam: 1.9% vs respiratory fluoroquinolone monotherapy: 1.5%, P = 0.588). No secondary outcomes were observed to differ significantly among groups. We observed no differences in clinical or safety outcomes among three guideline-recommended empiric CAP regimens. Empiric doxycycline + β-lactam may be a safe empiric regimen for hospitalized CAP patients with non-severe CAP, although additional research is needed to corroborate these observations with larger samples.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Aged, 80 and over / Anti-Bacterial Agents - administration & dosage / Anti-Bacterial Agents - adverse effects / Anti-Bacterial Agents - therapeutic use / Antibiotics / Aortic aneurysms / beta-Lactams - administration & dosage / beta-Lactams - adverse effects / beta-Lactams - therapeutic use / Blood pressure / Body mass index / Chronic obstructive pulmonary disease / Cohort analysis / Cohort Studies / Community-Acquired Infections - drug therapy / Community-acquired pneumonia / Comorbidity / Doxycycline / Drug Therapy, Combination / Electronic health records / Female / Fluoroquinolones - adverse effects / Fluoroquinolones - therapeutic use / Heart failure / Hospital Mortality / Hospitalization / Hospitalization - statistics & numerical data / Hospitals / Humans / Informatics / Internal Medicine / Length of Stay / Leukocytes / Macrolides - adverse effects / Macrolides - therapeutic use / Male / Mechanical ventilation / Medical records / Middle Aged / Mortality / Outcomes / Pathogens / Patients / Penicillin / Pneumonia / Pneumonia, Bacterial - drug therapy / Pneumonia, Bacterial - microbiology / Pneumonia, Bacterial - mortality / Regression analysis / Retrospective Studies / Risk factors / Sensitivity analysis / Staphylococcus infections / Streptococcus infections / Treatment Outcome / Ventilators / β-Lactam antibiotics