Extended-spectrum antibiotics for community-acquired pneumonia with a low risk for drug-resistant pathogens

• Published in: International journal of infectious diseases 2022-11, Vol.124, p.124-132
• Main Authors: Kobayashi, Hironori, Shindo, Yuichiro, Kobayashi, Daisuke, Sakakibara, Toshihiro, Murakami, Yasushi, Yagi, Mitsuaki, Matsuura, Akinobu, Sato, Kenta, Matsui, Kota, Emoto, Ryo, Yagi, Tetsuya, Saka, Hideo, Matsui, Shigeyuki, Hasegawa, Yoshinori
• Format: Article
• Language: English
• Subjects: Antibiotic resistance; Broad-spectrum antibiotics; Community-onset pneumonia; Empirical treatment; Mortality
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2022.09.015

•This study focused on the use of extended-spectrum antibiotics in patients with community-acquired pneumonia with a low risk for drug-resistant pathogens (DRPs).•Unnecessary extended-spectrum antibiotics use was defined by the 2019 community-acquired pneumonia guidelines.•Extended-spectrum antibiotics use was associated with increased 30-day mortality.•Risk assessment of DRPs is essential in determining empirical antibiotic therapy.•Extended-spectrum antibiotics use may be harmful in patients with a low risk for DRPs. The potential hazards of extended-spectrum antibiotic therapy for patients with community-acquired pneumonia (CAP) with low risk for drug-resistant pathogens (DRPs) remain unclear; however, risk assessment for DRPs is essential to determine the initial antibiotics to be administered. The study objective was to assess the effect of unnecessary extended-spectrum therapy on the mortality of such patients. A post hoc analysis was conducted after a prospective multicenter observational study for CAP. Multivariable logistic regression analysis was performed to assess the effect of extended-spectrum therapy on 30-day mortality. Three sensitivity analyses, including propensity score analysis to confirm the robustness of findings, were also performed. Among 750 patients with CAP, 416 with CAP with a low risk for DRPs were analyzed; of these, 257 underwent standard therapy and 159 underwent extended-spectrum therapy. The 30-day mortality was 3.9% and 13.8% in the standard and extended-spectrum therapy groups, respectively. Primary analysis revealed that extended-spectrum therapy was associated with increased 30-day mortality compared with standard therapy (adjusted odds ratio 2.82; 95% confidence interval 1.20-6.66). The results of the sensitivity analyses were consistent with those of the primary analysis. Physicians should assess the risk for DRPs when determining the empirical antibiotic therapy and should refrain from administering unnecessary extended-spectrum antibiotics for patients with CAP with a low risk for DRPs.