Empirical Antibiotic Coverage for Nosocomial Pneumonia Can Be De-Escalated

Nosocomial pneumonia commonly is caused by multidrug-resistant organisms, including Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). Guidelines from multiple organizations recommend empirical coverage of these bacteria (e.g., Clin Infect Dis 2016; 63:e61), and these antibiotics often are continued for 7 to 10 days when cultures are unrevealing. Although appropriate antibiotics, given early, are paramount in managing infections, risk for bacterial resistance rises with use of inappropriately broad antimicrobial agents.

Investigators in St. Louis retrospectively analyzed 279 patients from a single institution who were identified as having culture-negative nosocomial pneumonia. Nearly all patients received antipseu…