Abstract
Question Is broad-spectrum antibiotic use associated with poor outcomes in community-onset pneumonia after adjusting for confounders?
Methods We performed a retrospective, observational cohort study of 1995 adults with pneumonia admitted from four US hospital emergency departments. We used multivariable regressions to investigate the effect of broad-spectrum antibiotics on 30-day mortality, length of stay, cost and Clostridioides difficile infection (CDI). To address indication bias, we developed a propensity score using multilevel (individual provider) generalised linear mixed models to perform inverse-probability of treatment weighting (IPTW) to estimate the average treatment effect in the treated. We also manually reviewed a sample of mortality cases for antibiotic-associated adverse events.
Results 39.7% of patients received broad-spectrum antibiotics, but drug-resistant pathogens were recovered in only 3%. Broad-spectrum antibiotics were associated with increased mortality in both the unweighted multivariable model (OR 3.8, 95% CI 2.5–5.9; p<0.001) and IPTW analysis (OR 4.6, 95% CI 2.9–7.5; p<0.001). Broad-spectrum antibiotic use by either analysis was also associated with longer hospital stay, greater cost and increased CDI. Healthcare-associated pneumonia was not associated with mortality independent of broad-spectrum antibiotic use. In manual review we identified antibiotic-associated events in 17.5% of mortality cases.
Conclusion Broad-spectrum antibiotics appear to be associated with increased mortality and other poor outcomes in community-onset pneumonia.
Abstract
Despite propensity-based, weighted balancing including providers and adjustment for multiple patient-level confounders, broad-spectrum antibiotics appear to be associated with increased mortality and other poor outcomes in community-onset pneumonia http://bit.ly/2DafBax
Footnotes
This article has supplementary material available from erj.ersjournals.com
Author contributions: B.J. Webb had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: B.J. Webb and N.C. Dean. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: B.J. Webb, J. Sorensen and N.C. Dean. Critical review of the manuscript for important intellectual content: all authors. Statistical analysis: J. Sorensen and B.J. Webb.
Conflict of interest: B.J. Webb reports research support from Astellas Pharma, Inc. unrelated to this study and speaking honorarium from BioFire Diagnostics.
Conflict of interest: J. Sorensen has nothing to disclose.
Conflict of interest: A. Jephson has nothing to disclose.
Conflict of interest: I. Mecham has nothing to disclose.
Conflict of interest: N.C. Dean has nothing to disclose.
Support statement: A portion of this study was funded by a grant from the Intermountain Research and Medical Foundation. The Intermountain Research and Medical Foundation provided internal funding to support study coordinator salary and statistical analysis. No investigator salary support was provided. The funding body had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received January 8, 2019.
- Accepted April 1, 2019.
- Copyright ©ERS 2019
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