Racial disparities in antibiotic selection for community-acquired pneumonia in hospitalized patients

Abstract: Objective: Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality in the US. Studies report racial disparities in various infectious syndromes. Our objective was to assess the relationship between patient race and antibiotic prescribing in inpatient CAP management. Design: Retrospective cohort study. Setting: 11 Cleveland Clinic community hospitals. Patients: Patients aged ≥18 years hospitalized with CAP between November 1, 2022, and January 31, 2025. Methods: Parametric and non-parametric methods were used to describe demographic and clinical differences by race. The association between race and extended spectrum antibiotic (ESA) guideline concordance was assessed using multivariable logistic regression models adjusting for age, gender, admission source, area deprivation index (ADI), hospital, diabetes, cardiovascular disease, chronic respiratory disease, renal failure, liver disease, immunocompromising condition, alcohol and substance use disorder, dialysis, and clinical instability and severity on day 1. Results: In bivariate analyses, Non-Hispanic Black (NHB) patients were less likely than NHW patients to receive ESA guideline-concordant CAP therapy (63.2% vs 64.4%; OR = 0.91, P = .2). After adjusting for patient characteristics, there were no differences between NHB and NHW patients in receipt of ESA therapy (adjusted OR = 0.93; 95% CI = 0.83, 1.00). After adjusting for hospital, NHB patients were more likely to receive ESA guideline-concordant CAP therapy (adjusted OR = 1.17; 95% CI = 1.06, 1.30). Conclusion: NHB patients were more likely to receive ESA-guideline concordant therapy, but this was influenced by where they sought care. Further studies are needed to understand why prescribing varies across hospitals.