Associations Between Antibiotic Use and Outcomes in Patients Hospitalized With Community-Acquired Pneumonia and Positive Respiratory Viral Assays.

Details

• Alternative Title:
  Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 2026, v. 82, no. 4: Associations Between Antibiotic Use and Outcomes in Patients Hospitalized With Community-Acquired Pneumonia and Positive Respiratory Viral Assays.
• Journal Article:
  Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America
• Personal Author:
  Biebelberg, Brett ; Chen, Tom ; McKenna, Cara ; Kanjilal, Sanjat ; Shappell, Claire ; Rhee, Chanu ; Klompas, Michael
• Description:
  Newly released community-acquired pneumonia (CAP) guidelines include a conditional recommendation to treat all hospitalized patients with positive respiratory virus assays with antibacterials. We assessed the frequency, duration, and outcomes of antibacterial prescribing in this population.
  
  We retrospectively identified all hospitalized patients with possible CAP and a positive respiratory virus test at 5 hospitals, June 2015-December 2024. We used detailed clinical data to propensity-weight patients treated with 0-2 versus 5-7 days of antibacterials and compared outcomes overall and for different viruses.
  
  Among 6779 patients with possible CAP and a respiratory virus, 3269 were treated with 0-2 days and 1560 with 5-7 days of antibacterials. After propensity-weighting 2614 patients (1720 treated 0-2 days, 894 treated 5-7 days), there were no significant differences in hospital length of stay (11.7 days vs 11.1 days; OR 1.05, 95% CI .97-1.15), ICU admission after 48 hours (28.3% vs 28.2%; OR 1.01, 95% CI .86-1.18), in-hospital mortality (9.5% vs 9.8%; OR 0.97, 95% CI .74-1.27), or 30-day hospital-free days (16.9 days vs 17.0 days; OR 0.99, 95% CI .95-1.03). Results were consistent when restricted to non-SARS-CoV-2 viruses and to influenza alone, when comparing 0 versus 5-7 days of antibacterials, and when restricting to patients with ICD-10 codes for pneumonia present on admission.
  
  Antibacterial use for patients with possible CAP and respiratory viruses is highly variable but outcomes are similar with 0-2 versus 5-7 days of antibacterials. This suggests antibiotics are not beneficial in most CAP patients who test positive for respiratory viruses.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Community-Acquired Infections
  • Anti-Bacterial Agents
  • Male
  • Female
  • Retrospective Studies
  • Aged
  • Middle Aged
  • Hospitalization
  • Pneumonia
  More +
• Keywords:
  • Community-acquired pneumonia
  • respiratory viral infections
  • antibiotic stewardship
  • influenza
• Source:
  Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 2026, v. 82, no. 4
• DOI:
  https://doi.org/10.1093/cid/ciaf687
• ISSN:
  1058-4838 ; 1537-6591
• Pubmed ID:
  41378862
• Pubmed Central ID:
  PMC12965468
• Document Type:
  Text
• Funding:
  K08 HS029518/HS/AHRQ HHSUnited States/ ; U54 CK000611/CK/NCEZID CDC HHSUnited States/ ; Harvard Pilgrim Health Care Institute/ ; U54CK000611/US Centers for Disease Control and Prevention/
• Genre:
  Journal Article
• Pages in Document:
  630-638 (15 pdf pages)
• Volume:
  82
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:0ee400514d66591abf5e3b588f2b432b82426853e23cf8fdd8daa63da455aee2500b49d0554919b7e1a202417444018e3aa0cc7dac2f3f38cad4074beb7ff247