BACKGROUND Suspected pneumonia is the most common indication for antibiotics in hospitalized patients but is frequently overdiagnosed. We explored whether normal oxygenation could be used as an indicator to support early discontinuation of antibiotics. METHODS We retrospectively identified all patients started on antibiotics for pneumonia in 4 hospitals with oxygen saturations ≥95% on ambient air, May 2017-February 2021. We propensity-matched patients treated 1-2 days vs 5-8 days and compared hospital mortality and time to discharge using subdistribution hazard ratios (SHRs). Secondary outcomes included readmissions, 30-day mortality, Clostridioides difficile infections, hospital-free days, and antibiotic-free days. RESULTS Among 39 752 patients treated for possible pneumonia, 10 012 had median oxygen saturations ≥95% without supplemental oxygen. Of these, 2871 were treated 1-2 days and 2891 for 5-8 days; 4478 patients were propensity-matched. Patients treated 1-2 vs 5-8 days had similar hospital mortality (2.1% vs 2.8%; SHR, 0.75 [95% confidence interval {CI}, .51-1.09]) but less time to discharge (6.1 vs 6.6 days; SHR, 1.13 [95% CI, 1.07-1.19]) and more 30-day hospital-free days (23.1 vs 22.7; mean difference, 0.44 [95% CI, .09-.78]). There were no significant differences in 30-day readmissions (16.0% vs 15.8%; odds ratio [OR], 1.01 [95% CI, .86-1.19]), 30-day mortality (4.6% vs 5.1%; OR, 0.91 [95% CI, .69-1.19]), or 90-day C. difficile infections (1.3% vs 0.8%; OR, 1.67 [95% CI, .94-2.99]). CONCLUSIONS One-quarter of hospitalized patients treated for pneumonia had oxygenation saturations ≥95% on ambient air. Outcomes were similar with 1-2 vs 5-8 days of antibiotics. Normal oxygenation levels may help identify candidates for early antibiotic discontinuation. Prospective trials are warranted.

中文翻译：

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超短程抗生素治疗疑似肺炎并保留氧合。


背景疑似肺炎是住院患者使用抗生素最常见的适应症，但经常被过度诊断。我们探讨了正常氧合是否可以作为支持早期停用抗生素的指标。方法 我们回顾性地确定了 2017 年 5 月至 2021 年 2 月期间，4 家医院中环境空气氧饱和度≥95% 的所有开始使用抗生素治疗肺炎的患者。我们对治疗 1-2 天和 5-8 天的患者进行倾向匹配，并比较了医院死亡率和治疗死亡率。使用分区危险比 (SHR) 确定放电时间。次要结局包括再入院、30 天死亡率、艰难梭菌感染、非住院天数和非抗生素天数。结果 在 39 752 名可能患有肺炎的患者中，有 10 012 名患者在未补充氧气的情况下中位氧饱和度≥95%。其中，2871 人接受了 1-2 天的治疗，2891 人接受了 5-8 天的治疗； 4478 名患者进行了倾向匹配。治疗 1-2 天与 5-8 天的患者的医院死亡率相似（2.1% vs 2.8%；SHR，0.75 [95% 置信区间 {CI}，0.51-1.09]），但出院时间较短（6.1 天与 6.6 天；SHR，0.75 [95% 置信区间 {CI}，0.51-1.09]）。 SHR，1.13 [95% CI，1.07-1.19]）和更多 30 天无住院天数（23.1 vs 22.7；平均差，0.44 [95% CI，0.09-.78]）。 30 天再入院率（16.0% vs 15.8%；比值比 [OR]，1.01 [95% CI，0.86-1.19]）、30 天死亡率（4.6% vs 5.1%；OR，0.91）没有显着差异[95% CI, 0.69-1.19]），或 90 天艰难梭菌感染（1.3% vs 0.8%；OR，1.67 [95% CI, 0.94-2.99]）。结论 四分之一的肺炎住院患者的环境空气氧合饱和度≥95%。抗生素治疗 1-2 天与 5-8 天的结果相似。正常的氧合水平可能有助于确定早期停用抗生素的候选者。 前瞻性试验是有必要的。