Extended anaerobic coverage in aspiration pneumonia not associated with additional mortality benefit: Study

A recent study aimed to compare outcomes between antibiotic therapy with limited anaerobic coverage (LAC) versus extended anaerobic coverage (EAC) in patients with community-acquired aspiration pneumonia. This study was published in the journal Chest by Anthony D Bai and colleagues. Current guidelines do not recommend extended anaerobic coverage for aspiration pneumonia, yet it is still commonly prescribed.

A multicenter retrospective cohort study across 18 hospitals in Ontario, Canada, analyzed data from 3,999 patients diagnosed with community-acquired aspiration pneumonia between 2015 and 2022. Patients were categorized into LAC or EAC groups based on the antibiotics prescribed within 48 hours of admission. The primary outcome was in-hospital mortality, with Clostridioides difficile colitis incidence as a secondary outcome. Propensity score weighting was used to balance baseline factors between the two groups.

The key findings of the study were:

• Of the included patients, 2,683 received LAC and 1,316 received EAC.

• In-hospital mortality rates were 30.3% in the LAC group and 32.1% in the EAC group.

• Clostridioides difficile colitis occurred in ≤0.2% of the LAC group and 0.8% to 1.1% of the EAC group.

• After adjusting for baseline factors, the difference in in-hospital mortality between the EAC and LAC groups was 1.6%, with a 1.0% difference in Clostridioides difficile colitis risk.

The study suggests that extended anaerobic coverage does not provide additional benefits in terms of in-hospital mortality for patients with community-acquired aspiration pneumonia. However, it is associated with an increased risk of Clostridioides difficile colitis. These findings highlight the importance of aligning antibiotic therapy with evidence-based guidelines to optimize patient outcomes and minimize the risk of adverse events.

Reference:

Bai, A. D., Srivastava, S., Digby, G. C., Girard, V., Razak, F., & Verma, A. A. Anaerobic antibiotic coverage in aspiration pneumonia and the associated benefits and harms: A retrospective cohort study. Chest,2024. https://doi.org/10.1016/j.chest.2024.02.025