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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.

Author information

1
Intermountain Healthcare, Division of Infectious Diseases and Clinical Epidemiology, Salt Lake City, UT.
2
Stanford University, Division of Infectious Diseases and Geographic Medicine, Palo Alto, CA.
3
Intermountain Healthcare, Division of Pulmonary and Critical Care Medicine, Salt Lake City, UT.
4
Intermountain Healthcare, Division of Pulmonary and Critical Care, Utah Valley Regional Medical Center, Provo, UT.
5
University of Utah, Division of Pulmonary Medicine, Salt Lake City, UT.

Abstract

QUESTION:

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

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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

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