De-escalation versus continuation of empirical antimicrobial therapy in community-acquired pneumonia

摘要: Summary Objectives To compare mortality between de-escalation and continued empirical treatment in patients with community-acquired pneumonia. Methods Using a nationwide administrative database, we identified adult pneumonia caused by Streptococcus pneumoniae , other streptococci, Haemophilus influenzae Klebsiella or Escherichia coli (n = 10,231) of unknown etiology (n = 8247), discharged July 2010 March 2013. De-escalation was determined the spectrum number antimicrobials at day 4. We used propensity score matching to obtain 489 pairs continuation groups among pathogen-identified 278 culture-negative mortalities. Results In patients, noninferior 15-day [5.3% versus 4.3% continuation, difference 1.0% (95% confidence interval, −1.7% 3.7%)] in-hospital [8.0% 8.8% −0.8% −4.3% 2.7%)]. cases, terms but not mortality. Conclusions Among specific etiology, treatment, suggesting that is safe strategy supporting current recommendations. Safety cases questionable.