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Ultra-Short-Course Antibiotics for Suspected Pneumonia With Preserved Oxygenation
Michael Klompas1,2, Caroline McKenna1, Aileen Ochoa1
1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Background:
Suspected pneumonia is the most common indication for antibiotics in hospitalized patients but is frequently overdiagnosed. We explored whether normal oxygenation could be used as an indicator to support early discontinuation of antibiotics.
Methods:
We retrospectively identified all patients started on antibiotics for pneumonia in 4 hospitals with oxygen saturations ≥95% on ambient air, May 2017-February 2021. We propensity-matched patients treated 1-2 days vs 5-8 days and compared hospital mortality and time to discharge using subdistribution hazard ratios (SHRs). Secondary outcomes included readmissions, 30-day mortality, Clostridioides difficile infections, hospital-free days, and antibiotic-free days.
Results:
Among 39 752 patients treated for possible pneumonia, 10 012 had median oxygen saturations ≥95% without supplemental oxygen. Of these, 2871 were treated 1-2 days and 2891 for 5-8 days; 4478 patients were propensity-matched. Patients treated 1-2 vs 5-8 days had similar hospital mortality (2.1% vs 2.8%; SHR, 0.75 [95% confidence interval {CI}, .51-1.09]) but less time to discharge (6.1 vs 6.6 days; SHR, 1.13 [95% CI, 1.07-1.19]) and more 30-day hospital-free days (23.1 vs 22.7; mean difference, 0.44 [95% CI, .09-.78]). There were no significant differences in 30-day readmissions (16.0% vs 15.8%; odds ratio [OR], 1.01 [95% CI, .86-1.19]), 30-day mortality (4.6% vs 5.1%; OR, 0.91 [95% CI, .69-1.19]), or 90-day C. difficile infections (1.3% vs 0.8%; OR, 1.67 [95% CI, .94-2.99]).
Conclusions:
One-quarter of hospitalized patients treated for pneumonia had oxygenation saturations ≥95% on ambient air. Outcomes were similar with 1-2 vs 5-8 days of antibiotics. Normal oxygenation levels may help identify candidates for early antibiotic discontinuation. Prospective trials are warranted.
Insights
Normal oxygenation in hospitalized patients may allow for shorter antibiotic durations for pneumonia. This study found similar outcomes with 1-2 days versus 5-8 days of antibiotics, suggesting potential for early discontinuation.
Area of Science:
- Infectious Diseases
- Pulmonology
- Clinical Pharmacy
Background:
- Pneumonia is a common reason for antibiotic use in hospitalized patients.
- Antibiotic overuse for pneumonia is frequent, leading to concerns about resistance and side effects.
- Investigating alternative clinical indicators for antibiotic de-escalation is crucial.
Purpose of the Study:
- To determine if normal oxygenation (≥95% on ambient air) can support early discontinuation of antibiotics in suspected pneumonia.
- To compare outcomes between short-term (1-2 days) and standard-term (5-8 days) antibiotic treatment in patients with normal oxygenation.
Main Methods:
- Retrospective analysis of hospitalized patients treated for pneumonia with oxygen saturation ≥95% on ambient air.
- Propensity-matched comparison of patients receiving 1-2 days versus 5-8 days of antibiotics.
- Evaluation of hospital mortality, time to discharge, readmissions, and other secondary outcomes.
Main Results:
- Among 10,012 patients with normal oxygenation, 1-2 days of antibiotics showed similar hospital mortality compared to 5-8 days.
- Shorter antibiotic duration (1-2 days) was associated with less time to discharge and more hospital-free days.
- No significant differences were observed in 30-day readmissions, 30-day mortality, or Clostridioides difficile infections.
Conclusions:
- Approximately 25% of hospitalized pneumonia patients exhibit normal oxygenation on room air.
- Shortening antibiotic courses to 1-2 days in patients with normal oxygenation appears safe and effective.
- Normal oxygenation may serve as a biomarker for identifying candidates for early antibiotic discontinuation, warranting prospective validation.
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