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Eur Respir J. 2019 Apr 25. pii: 1900057. doi: 10.1183/13993003.00057-2019. [Epub ahead of print]

Broad-spectrum antibiotic use and poor outcomes in community-onset pneumonia: a cohort study.

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Intermountain Healthcare, Division of Infectious Diseases and Clinical Epidemiology, Salt Lake City, UT.
Stanford University, Division of Infectious Diseases and Geographic Medicine, Palo Alto, CA.
Intermountain Healthcare, Division of Pulmonary and Critical Care Medicine, Salt Lake City, UT.
Intermountain Healthcare, Division of Pulmonary and Critical Care, Utah Valley Regional Medical Center, Provo, UT.
University of Utah, Division of Pulmonary Medicine, Salt Lake City, UT.



Is broad-spectrum antibiotic use associated with poor outcomes in community-onset pneumonia after adjusting for confounders?


Retrospective, observational cohort study of 1995 adults with pneumonia admitted from 4 United States hospital emergency departments. We used multivariable regressions to investigate the effect of broad-spectrum antibiotics on 30-day mortality, length of stay, cost, and Clostridioides difficile infection. To address indication bias, we developed a propensity score using multilevel (individual provider) generalised linear mixed models to perform inverse-probability of treatment weighting (IPTW) to estimate the average treatment effect in the treated (ATT). We also manually reviewed a sample of mortality cases for antibiotic-associated adverse events.


39.7% of patients received broad-spectrum antibiotics, but drug-resistant pathogens were recovered in only 3%. Broad-spectrum antibiotics were associated with increased mortality in both the unweighted multivariable model (OR 3.8, CI 2.5-5.9, p<0.001) and IPTW analysis (OR 4.6, CI 2.9-7.5, p<0.001). Broad-spectrum antibiotic use by either analysis was also associated with longer hospital stay, greater costs, and increased C. difficile infection. Healthcare- associated pneumonia (HCAP) was not associated with mortality independent of broad-spectrum antibiotic use. In manual review we identified antibiotic-associated events in 17.5% of mortality cases.


Broad-spectrum antibiotics appear to be associated with increased mortality and other poor outcomes in community-onset pneumonia.

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