Practice patterns for antibiotic de-escalation in culture-negative healthcare-associated pneumoniaReport as inadecuate

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, Volume 38, Issue 5, pp 357–362

First Online: 21 July 2010Received: 22 March 2010Accepted: 28 June 2010


BackgroundPublished guidelines for the treatment of healthcare-associated pneumonia HCAP recommend initial broad-spectrum antibiotics with appropriate de-escalation based on culture results. Guideline recommendations are based on data from intubated patients, in whom cultures are easily obtained. The approach to antibiotic de-escalation for culture-negative patients has not been addressed. Consequently, there are no published reports that describe the current standard of practice.

Patients and methodsAll patients admitted to a university hospital with a diagnosis of HCAP, as defined by use of a pneumonia orderset, were identified retrospectively over a 2-year period. Antibiotics prescribed on admission, during hospital stay, and on discharge were recorded. De-escalation was defined as a change in the initial antibiotic therapy from broad- to narrow-spectrum coverage within 14 days of the initial prescription. The Pneumonia Severity Index was used for risk-adjustment.

ResultsA total of 102 patients were included in the analysis; of these, 72% n = 73 were culture-negative. There were more males in the culture-negative than culture-positive group; otherwise, baseline characteristics were similar. Antibiotic therapy was de-escalated in 75% of the culture-negative group and 77% of the culture-positive group p = 1.00. Culture-negative patients were de-escalated approximately 1 day earlier than culture-positive patients 3.93 vs. 5.04 days, p = 0.03. Culture-negative patients who were de-escalated had a shorter length of hospitalization, lower hospital costs, and lower mortality rates. In 70% of the culture-negative patients, a respiratory fluoroquinolone was chosen for de-escalation.

ConclusionIn this single-center study, most of the patients with culture-negative HCAP were safely de-escalated to a respiratory fluoroquinolone.

KeywordsHCAP Culture negative Healthcare-associated pneumonia Antibiotic de-escalation Respiratory fluoroquinolone  Download fulltext PDF

Author: M. Schlueter - C. James - A. Dominguez - L. Tsu - G. Seymann


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