Study: ‘Ultrashort’ antibiotic course OK for pneumonia with normal oxygenation
Click Here to Manage Email Alerts
Patients with normal oxygenation levels who were treated for possible pneumonia experienced similar outcomes with an “ultrashort” course of antibiotics compared with a longer course, researchers reported recently.
The study found no clinically significant differences in length of stay, mortality or readmissions among patients treated with antibiotics for 1 to 2 days compared with those treated for 5 to 8 days.
“This study was prompted by our clinical observations that we frequently encountered hospitalized patients that primary teams had started on antibiotics for possible pneumonia, yet on review of their vital signs, their oxygenation levels were normal,” Michael Klompas, MD, MPH, professor of population medicine at Harvard Medical School and hospital epidemiologist at Brigham and Women’s Hospital in Boston, told Healio.
This prompted Klompas and colleagues to assess if this was just a subjective impression or if the pattern is widespread.
“We found that it was actually quite common. About a third of patents across four hospitals started on antibiotics with a stated indication of pneumonia had median oxygen saturations 95% or more without supplemental oxygen,” Klompas said.
“This is striking,” Klompas said, “because pneumonia by definition involves invasion of the lung parenchyma with infection, so one would expect some degree of impaired oxygenation in most patients.”
From there, the researchers wondered whether it is possible to safely stop antibiotics for these patients, even if they have only been on treatment for 1 or 2 days rather than a typical 5 or more days of treatment.
They retrospectively identified all patients started on antibiotics for pneumonia in four hospitals who had oxygen saturations 95% or more on ambient air between May 2017 and February 2021.
They compared patients treated for 1 to 2 days with those treated for 5 to 8 days for hospital mortality and time-to-discharge. Secondary outcomes included readmissions, 30-day mortality, Clostridioides difficile infections, hospital-free days and antibiotic-free days.
Among the 39,752 patients treated for possible pneumonia, 10,012 had median oxygen saturations of 95% or more without supplemental oxygen. Of these, 2,871 were treated for 1 to 2 days, 2,891 for 5 to 8 days.
The study found that patients treated for 1 to 2 days vs. those treated for 5 to 8 days had similar rates of hospital mortality (2.1% vs. 2.8%, SHR = 0.75; 95% CI, 0.51-1.09) 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; 95% CI, 0.09-0.78).
There were no significant differences in 30-day readmissions (16% vs. 15.8%; OR = 1.01; 95% CI, 0.86-1.19), 30-day mortality (4.6% vs. 5.1%; OR = 0.91; 95% CI, 0.69-1.19), or 90-day C. difficile infections (1.3% vs. 0.8%; OR = 1.67; 95% CI, 0.94-2.99).
Klompas said that the findings suggest a “very practical, clinically intuitive, low-tech and low-cost strategy” that clinicians can use to decide which patients need a full course of antibiotics for possible pneumonia and which might be candidates for early discontinuation of antibiotics.
“It gets at the challenge clinicians commonly face at the bedside on deciding whether a patient has pneumonia or not. It can be quite a difficult diagnosis in patients with ambiguous findings,” he said. “Given how common it is that patients are started on antibiotics for possible pneumonia despite preserved oxygenation — a quarter to a third of pneumonias — we think this strategy could have a significant impact on decreasing antibiotic utilization for suspected respiratory infections.”
In the study, Klompas and colleagues said there were likely several factors that contributed to the lack of a benefit of conventional antibiotic courses for these patients, including that some may not have had pneumonia and others may have had viral — and not bacterial — pneumonia.
“One third to one half of community-acquired pneumonias in hospitalized patients and one fifth of hospital-acquired pneumonias are attributable to viruses,” they wrote.
Collapse
Read more about
Click Here to Manage Email Alerts