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In 2005, a formal classification of “healthcare-associated pneumonia” was added to pneumonia-treatment guidelines, specifying that patients with substantial exposure to microbial flora in hospitals or other residential facilities start treatment with broad-spectrum antibiotics directed at multidrug-resistant pathogens (Am J Respir Crit Care Med 2005; 171:388). In theory, this mandate should have resulted in better matches between initial treatment and infecting organisms, as well as improved treatment outcomes, in pneumonia patients. To explore this premise, Veterans Affairs (VA) researchers correlated initial antibiotic choices with culture results in >95,000 pneumonia hospitalizations in VA medical centers nationwide.
From 2006 through 201…