This study conducted a retrospective analysis of antibiotic treatment in patients with community-acquired pneumonia (CAP) at Australian tertiary hospitals, investigating the association between guideline-concordant antibiotic therapy and short-term/long-term mortality. The research found that 51.4% of patients received guideline-recommended antibiotic treatment, which was significantly linked to reduced 30-day mortality and showed a declining trend in one-year mortality. The study adjusted for multiple critical confounding factors, including frailty status and cardiovascular medication use, demonstrating high methodological rigor.
Literature Overview
This article, titled 'Guideline-Concordant Antibiotic Treatment for Hospitalised Patients with Community-Acquired Pneumonia and Clinical Outcomes at a Tertiary Hospital in Australia', published in the journal Antibiotics, reviews clinical outcomes of guideline-recommended antibiotic treatment among 241 adult CAP patients hospitalised and radiologically confirmed between January 1, 2023, and December 31, 2023. The study employed propensity score matching (PSM) to adjust for age, comorbidities, frailty status, and pneumonia severity to mitigate confounding factors.
Background Knowledge
Community-acquired pneumonia (CAP) is a common and severe infectious disease globally, particularly with significantly increased morbidity and mortality in elderly and immunocompromised populations. Although multiple international and local treatment guidelines exist, adherence to recommended antibiotic regimens remains suboptimal in clinical practice. Previous studies have demonstrated that guideline-concordant antibiotic treatment can reduce hospitalisation duration and treatment failure rates, yet its impact on long-term mortality remains controversial. This study provides novel evidence through rigorous retrospective analysis and PSM methodology, representing the first evaluation of guideline-recommended treatment effects on short- and long-term mortality and other clinical outcomes in CAP patients within Australian tertiary hospital settings.
Research Methods and Experiments
This retrospective cohort study included 241 adult patients hospitalised for radiologically confirmed CAP at an Australian tertiary hospital in 2023. Patients with hospital-acquired pneumonia or SARS-CoV-2 infection were excluded. Primary endpoints included all-cause mortality during hospitalisation, 30-day, and one-year mortality. Secondary endpoints encompassed ICU admission, invasive ventilatory support, vasopressor use, length of hospital stay, and 30-day readmission rates. Propensity score matching (PSM) adjusted for 16 covariates including age, comorbidity burden (Charlson Comorbidity Index), frailty status (Hospital Frailty Risk Score), and pneumonia severity (SMART-COP score). Sensitivity analyses were conducted to evaluate treatment effects in patients aged ≥80 years and those with moderate-to-severe pneumonia (SMART-COP > 2).
Key Conclusions and Perspectives
Research Significance and Prospects
This investigation highlights the importance of guideline adherence in antibiotic selection for improving short-term outcomes in CAP patients, particularly among elderly and moderate-to-severe pneumonia cohorts. Findings support enhanced implementation of guideline-concordant antibiotic protocols to improve survival rates. However, as a retrospective study lacking specific mortality data, prospective randomised controlled trials are required to validate the potential long-term benefits of guideline-recommended antibiotics, particularly regarding cardiovascular mortality. Further research should explore antibiotic selection mechanisms related to immune modulation and their role in post-CAP chronic inflammation and cardiovascular risk, while optimising treatment strategies through integration of frailty assessments and comorbidity evaluations to balance antibiotic choice with multidrug-resistance risks.
Conclusion
This systematic evaluation confirms that guideline-concordant antibiotic treatment in Australian tertiary hospitals significantly improves short-term survival in CAP patients, with promising trends in one-year mortality reduction. While unadjusted analysis suggested higher hospital mortality in guideline-adherent groups, rigorous PSM adjustment revealed significant 30-day mortality benefits, particularly in elderly and moderate-to-severe pneumonia populations. These outcomes may relate to enhanced pathogen coverage and immune modulation effects. However, the retrospective design and limited sample size prevent definitive conclusions about cardiovascular mortality reduction. Future large-scale prospective studies are needed to validate these findings, elucidate mechanistic links between antibiotic therapy and post-CAP chronic inflammation/cardiovascular risks, and develop individualised treatment strategies incorporating frailty and comorbidity assessments to optimise overall CAP outcomes.
