Background The 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) community-acquired pneumonia (CAP) guidelines recommend that clinicians prescribe empiric antibiotics for methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa only if locally validated risk factors (or 2 generic risk factors if local validation is not feasible) are present. Methods In this cross-sectional study that included adults hospitalized for CAP across 50 hospitals in the Premier Healthcare Database from 2010 to 2015, we sought to describe how the use of extended-spectrum antibiotics (ESAs) and the coverage for patients with CAP due to restraint organisms would change under the 2 approaches described in the 2019 ATS/IDSA guidelines. The proportion of ESA use in patients with CAP and the proportion of ESA coverage among patients with infections resistant to recommended CAP therapy were measured. Results In the 50 hospitals, 19%–75% of patients received ESAs, and 42%–100% of patients with resistant organisms received ESAs. The median number of risk factors identified per hospital was 9 (interquartile range, 6–12). Overall, treatment according to local risk factors reduced the number of patients receiving ESAs by 38.8 percentage points and by 47.5 percentage points when using generic risk factors. However, the effect varied by hospital. The use of generic risk factors always resulted in less ESA use and less coverage for resistant organisms. Using locally validated risk factors resulted in a similar outcome in all but 1 hospital. Conclusions Future guidelines should explicitly define the optimal trade-off between adequate coverage for resistant organisms and ESA use.

中文翻译：

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在美国医院社区获得性肺炎患者中使用当地验证的耐药病原体危险因素的潜在影响：一项横断面研究


背景 2019 年美国胸科学会/美国传染病学会 （ATS/IDSA） 社区获得性肺炎 （CAP） 指南建议，临床医生只有在存在当地验证的危险因素（如果当地验证不可行，则存在 2 个一般危险因素）的情况下，才为耐甲氧西林金黄色葡萄球菌或铜绿假单胞菌开具经验性抗生素。方法 在这项横断面研究中，包括 2010 年至 2015 年 Premier Healthcare Database 中 50 家医院因 CAP 住院的成人，我们试图描述超广谱抗生素 （ESA） 的使用和约束微生物引起的 CAP 患者的覆盖范围在 2019 年 ATS/IDSA 指南中描述的 2 种方法下将如何变化。测量 CAP 患者 ESA 使用的比例和对推荐的 CAP 治疗耐药的感染患者中 ESA 覆盖率的比例。结果 在 50 家医院中，19%-75% 的患者接受了 ESA，42%-100% 的耐药微生物患者接受了 ESA。每家医院确定的风险因素中位数为 9 （四分位距，6-12）。总体而言，根据当地风险因素进行治疗可将接受 ESA 的患者人数减少 38.8 个百分点，在使用通用风险因素时减少 47.5 个百分点。然而，效果因医院而异。使用通用风险因素总是导致 ESA 使用减少，对耐药生物体的覆盖率降低。使用当地验证的风险因素在除 1 家医院外的所有医院都产生了相似的结果。结论 未来的指南应明确定义对耐药生物的充分覆盖与 ESA 使用之间的最佳权衡。