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In patients hospitalized with an infection suggestive of pneumonia, the early discontinuation of antibiotic treatment may be safe among those with normal oxygen saturation levels, according to results of a multicenter retrospective study published in Clinical Infectious Diseases.
Researchers conducted a study among adult patients at 4 hospitals in Massachusetts who were receiving antibiotic treatment for an infection suggestive of pneumonia between May 2017 and February 2021. Included patients had a median daily oxygen saturation of at least 95% on room air and did not require supplemental oxygen within the first 2 days following antibiotic treatment initiation. Propensity-score matching was used to compare outcomes between patients who received either 1 to 2 days (group 1) or 5 to 8 days (group 2) of antibiotic treatment. The researchers calculated subdistribution hazard ratios (SHRs) via Fine and Gray regression to compare the rate of in-hospital mortality and differences in the time to discharge between the 2 patients groups. Secondary outcomes were estimated via logistic regression and included the risk of 30-hospital readmission, 30-day mortality, and testing positive for Clostridioides difficile infection within 90 days.
There were 4,478 patients included in the final analysis (n=2239 for each group), of whom the mean age was 66 years, 55% were men, and 68% were White. The most common comorbidities among the patients included diabetes (28%), kidney failure (26%), congestive heart failure (26%), and cancer (23%).
Although the rate of 30-day mortality did not significantly differ between patients in group 1 vs group 2 (2.1% vs 2.8%; SHR, 0.75; 95% CI, 0.51-1.09), the time to hospital discharge was significantly different (6.1 vs 6.6 days; SHR, 1.13; 95% CI, 1.07-1.19; P =.04). Further analysis showed that the number of hospital-free days within 30 days of treatment initiation also was significantly increased among patients in groups 1 vs 2 (23.1 vs 22.7; mean difference, 0.44; 95% CI, 0.09-0.78; P =.02).
No significant differences between patients in groups 1 vs 2 were observed when comparing 30-day readmission rates (16.0% vs 15.8%), 30-day mortality rates (4.6% vs 5.1%), or 90-day positivity rates for C difficile infection (1.3% vs 0.8%).
These results were similar after the analysis was restricted to patients with positive sputum cultures and those with a discharge diagnosis of pneumonia.
This study was limited by its observational design, potential residual confounding, and potentially limited generalizability.
According to the researchers, the “early discontinuation of antibiotics started for possible pneumonia in hospitalized patients with normal oxygenation merits testing in a prospective randomized trial to confirm or refute the feasibility, safety, and utility of this strategy for reducing unnecessary antibiotic use.”
Disclosure: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Klompas M, McKenna C, Ochoa A, et al. Ultrashort course antibiotics for suspected pneumonia with preserved oxygenation. Clin Infect Dis. Published online July 27, 2022. doi:10.1093/cid/ciac616
