Evaluation of Antimicrobial Therapy Duration for Hospital-Acquired Pneumonia Treatment

Background The Infectious Diseases Society of America recommends a 7-day duration of antimicrobial therapy for hospital-acquired pneumonia (HAP); however, this recommendation is based on low-quality evidence. This recommendation is supported by evidence from ventilator-associated pneumonia clinical trials. Use of guideline-recommended antimicrobial durations is variable in clinical practice owing to the lack of literature available. Methods This was a retrospective, cohort, single-center study. Adult patients admitted with a diagnosis of HAP and received at least 72 hours of antimicrobial therapy were included. The primary outcome was day 7 clinical stability in patients treated with standard (≤7 days) compared with extended (>7 days) duration antimicrobial therapy. Secondary outcomes included hospital and intensive care unit length of stay (LOS), 30-day mortality, and 30-day hospital readmission rates. Results Fifty-three patient encounters were identified. Thirty-two patients (60.4%) received standard duration (6 [4.5–7] days) antimicrobial therapy, and 21 patients (39.6%) received extended duration (14 [11–14] days) antimicrobial therapy ( P < 0.001). There were no statistically significant differences between groups with respect to day 7 clinical stability (62.5% vs 47.6%; P = 0.29), hospital LOS (9 [7–16] days vs 12 [7.5–24] days; P = 0.29), intensive care unit LOS (5 [3.5–9.5] days vs 5 [3–20] days; P = 0.62), 30-day mortality (3.1% vs 9.5%; P = 0.56), or 30-day readmission rates (21.9% vs 38.1%; P = 0.2). Conclusions No differences were observed in clinical outcomes between antimicrobial treatment groups. Guideline-recommended durations of antimicrobial therapy should be used in patients with HAP.