Reviewed by: Geeta Sood, MD, ScM, Johns Hopkins University
In this study of 31,183 patients admitted to one of 124 veterans administrations (VA) hospitals across the US with either a primary diagnosis of community-acquired pneumonia or a primary diagnosis of sepsis or respiratory failure and a secondary diagnosis of community-acquired pneumonia from 2018-2023 were included. Fifty-five percent of admissions who were eligible for switch to PO antibiotic therapy, were switched before day 3 (range 30-80% among hospitals). Observed to expected ratios were calculated based on patient comorbidities to account for possible differences in patient populations.
Interestingly 27% of patients were prescribed broad-spectrum antibiotics for a primary diagnosis of community-acquired pneumonia and 4.2% were prescribed fluroquinolones alone.
This is an important finding given that there is considerable variability among hospitals at these rates, which may make it an important comparative quality measure. In some cases, there may be utilization and payer incentives to continue patients on IV antibiotics, however this is less likely to be a concern in VA hospitals. It would be helpful to understand more about the patients who were continued on IV antibiotics. Was there concern for aspiration? Were there microbiologic results that may have influenced the decision to continue IV antibiotics?
This study challenges us to improve efforts to switch to oral antibiotics for community-acquired pneumonia whenever possible.
Reference:
Daniels L, Heintz B, Lund B, Alexander B, Livorsi D. Frequency of intravenous-to-oral antibiotic switch in VA hospitalized patients with community-acquired pneumonia. Infect Control Hosp Epidemiol. 2026 Feb 2:1-8. doi: 10.1017/ice.2025.10389. Epub ahead of print. PMID: 41623152.
