Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia: A Multihospital Cohort Study
Open accessAbstract
Background: Randomized trials demonstrate no benefit from antibiotic treatment exceeding the shortest effective duration. Objective: To examine predictors and outcomes associated with excess duration of antibiotic treatment. Design: Retrospective cohort study. Setting: 43 hospitals in the Michigan Hospital Medicine Safety Consortium. Patients: 6481 general care medical patients with pneumonia. Measurements: The primary outcome was the rate of excess antibiotic treatment duration (excess days per 30-day period). Excess days were calculated by subtracting each patient's shortest effective (expected) treatment duration (based on time to clinical stability, pathogen, and pneumonia classification [community-acquired vs. health care-associated]) from the actual duration. Negative binomial generalized estimating equations (GEEs) were used to calculate rate ratios to assess predictors of 30-day rates of excess duration. Patient outcomes, assessed at 30 days via the medical record and telephone calls, were evaluated using logit GEEs that adjusted for patient characteristics and probability of treatment. Results: Two thirds (67.8% [4391 of 6481]) of patients received excess antibiotic therapy. Antibiotics prescribed at discharge accounted for 93.2% of excess duration. Patients who had respiratory cultures or nonculture diagnostic testing, had a longer stay, received a high-risk antibiotic in the prior 90 days, had community-acquired pneumonia, or did not have a total antibiotic treatment duration documented at discharge were more likely to receive excess treatment. Excess treatment was not associated with lower rates of any adverse outcomes, including death, readmission, emergency department visit, or Clostridioides difficile infection. Each excess day of treatment was associated with a 5% increase in the odds of antibiotic-associated adverse events reported by patients after discharge. Limitation: Retrospective design; not all patients could be contacted to report 30-day outcomes. Conclusion: Patients hospitalized with pneumonia often receive excess antibiotic therapy. Excess antibiotic treatment was associated with patient-reported adverse events. Future interventions should focus on whether reducing excess treatment and improving documentation at discharge improves outcomes. Primary Funding Source: Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network as part of the BCBSM Value Partnerships program.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In many RCTs of shorter versus longer antimicrobial courses for specific conditions, the shorter course was as effective as the longer course but associated with fewer adverse consequences.
“In many of the trials, the shorter course was just as effective as the longer course but associated with fewer adverse consequences.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [289]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Austin, P. C. (2011) · Multivariate Behavioral Research · doi:10.1080/00273171.2011.568786 · Cited by 12,242 · see citing works
Mandell, L. A., Wunderink, R. G., Anzueto, A., Bartlett, J. G., Campbell, G. D., Dean, N. C., Dowell, S. F., File, T. M., Musher, D. M., Niederman, M. S., et al. (2007) · Clinical Infectious Diseases · doi:10.1086/511159 · Cited by 6,182 · see citing works
(2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200405-644st · Cited by 5,870 · see citing works
Kalil, A. C., Metersky, M. L., Klompas, M., Muscedere, J., Sweeney, D. A., Palmer, L. B., Napolitano, L. M., O'Grady, N. P., Bartlett, J. G., Carratalà, J., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw353 · Cited by 3,892 · see citing works
Barlam, T. F., Cosgrove, S. E., Abbo, L. M., MacDougall, C., Schuetz, A. N., Septimus, E. J., Srinivasan, A., Dellit, T. H., Falck-Ytter, Y. T., Fishman, N. O., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw118 · Cited by 3,147 · see citing works
Self-citationCostelloe, C., Metcalfe, C., Lovering, A., Mant, D., & Hay, A. D. (2010) · BMJ · doi:10.1136/bmj.c2096 · Cited by 1,981 · see citing works
Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014.
Rhee, C., Dantes, R., Epstein, L., Murphy, D. J., Seymour, C. W., Iwashyna, T. J., Kadri, S. S., Angus, D. C., Danner, R. L., Fiore, A. E., et al. (2017) · JAMA · doi:10.1001/jama.2017.13836 · Cited by 1,884 · see citing works
Model Selection: An Integral Part of Inference
Buckland, S. T., Burnham, K. P., & Augustin, N. H. (1997) · Biometrics · doi:10.2307/2533961 · Cited by 1,717 · see citing works
Chastre, J., Wolff, M., Fagon, J.-Y., Chevret, S., Thomas, F., Wermert, D., Clementi, E., Gonzalez, J., Jusserand, D., Asfar, P., et al. (2003) · JAMA · doi:10.1001/jama.290.19.2588 · Cited by 1,376 · see citing works
Niederman, M. S., Bass, J. B., Campbell, G. D., et al. (1993) · American Review of Respiratory Disease · doi:10.1164/ajrccm/148.5.1418 · Cited by 1,048 · see citing works
Singh, N., ROGERS, P., Atwood, C. W., Wagener, M. M., & Yu, V. L. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.162.2.9909095 · Cited by 1,020 · see citing works
Association of adverse events with antibiotic use in hospitalized patients.
Tamma, P. D., Avdic, E., Li, D. X., Dzintars, K., & Cosgrove, S. E. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.1938 · Cited by 800 · see citing works
Pollack, L. A., & Srinivasan, A. (2014) · Clinical Infectious Diseases · doi:10.1093/cid/ciu542 · Cited by 576 · see citing works
Self-citationBean (2004) · doi:10.1111/(issn)1532-5415 · Cited by 431 · see citing works
Vital signs: improving antibiotic use among hospitalized patients.
Fridkin, S. K., Baggs, J. M., Fagan, R. P., Magill, S. S., Pollack, L. A., Malpiedi, P. J., Slayton, R. B., Khader, K., Rubin, M. A., Jones, M., et al. (2014) · PubMed Central · Cited by 392 · see citing works
Self-citationRisk Factors for Adverse Drug Events Among Older Adults in the Ambulatory Setting
Field, T., Gurwitz, J., Harrold, L., Rothschild, J., Debellis, K., Seger, A., Auger, J. C., Garber, L., Cadoret, C. A., Fish, L., et al. (2004) · Journal of The American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52367.x · Cited by 315 · see citing works
Duration of Antibiotic Treatment in Community-Acquired Pneumonia
Uranga, A., España, P. P., Bilbao, A., Quintana, J. M., Arriaga, I., Intxausti, M., Lobo, J. L., Tomás, L., Camino, J., Nuñez, J. M., et al. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.3633 · Cited by 292 · see citing works
Effect of Short-Course, High-Dose Amoxicillin Therapy on Resistant Pneumococcal Carriage
Schrag, S. J., Peña, C., Fernández, J., Sánchez, J., Gómez, V., Pérez-Then, E. N., Feris, J. M., & Besser, R. E. (2001) · JAMA · doi:10.1001/jama.286.1.49 · Cited by 233 · see citing works
Lautenbach, E., Strom, B. L., Bilker, W. B., et al. (2001) · Clinical Infectious Diseases · doi:10.1086/322667 · Cited by 227 · see citing works
García‐Vázquez, E., Marcos, M. Á., Mensa, J., et al. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.16.1807 · Cited by 218 · see citing works
Efficacy of Short-Course Antibiotic Regimens for Community-Acquired Pneumonia: A Meta-analysis
Li, J. Z., Winston, L. G., Moore, D. H., & Bent, S. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2007.04.023 · Cited by 194 · see citing works
Pollack, L. A., van Santen, K. L., Weiner, L. M., Dudeck, M. A., Edwards, J. R., & Srinivasan, A. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw323 · Cited by 178 · see citing works
Self-citationAvdic, E., Cushinotto, L., Hughes, A. H., Hansen, A. R., Efird, L. E., Bartlett, J. G., & Cosgrove, S. E. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis242 · Cited by 146 · see citing works
Freedberg, D. E., Salmasian, H., Cohen, B., Abrams, J. A., & Larson, E. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.6193 · Cited by 133 · see citing works
Efficacy of Short-Course Antibiotic Regimens for Community-Acquired Pneumonia: A Meta-analysis
Maurer, J. (2009) · Yearbook of Pulmonary Disease · doi:10.1016/s8756-3452(08)79054-6 · Cited by 123 · see citing works
Flanders, S. A., Greene, M. T., Grant, P., et al. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.3384 · Cited by 104 · see citing works
Self-citationDetection, Treatment, and Prevention of Clostridium difficile Infection
McCollum, D. L., & Rodriguez, J. M. (2012) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2012.03.008 · Cited by 98 · see citing works
Royer, S., DeMerle, K. M., Dickson, R. P., & Prescott, H. C. (2018) · Journal of Hospital Medicine · doi:10.12788/jhm.2905 · Cited by 94 · see citing works
The Association Between PICC Use and Venous Thromboembolism in Upper and Lower Extremities
Greene, M. T., Flanders, S. A., Woller, S. C., et al. (2015) · The American Journal of Medicine · doi:10.1016/j.amjmed.2015.03.028 · Cited by 86 · see citing works
Self-citationDrahos, J., VanWormer, J. J., Greenlee, R. T., Landgren, O., & Koshiol, J. E. (2013) · Annals of Epidemiology · doi:10.1016/j.annepidem.2013.02.005 · Cited by 75 · see citing works
Yi, S. H., Hatfield, K. M., Baggs, J. M., et al. (2017) · Clinical Infectious Diseases · doi:10.1093/cid/cix986 · Cited by 73 · see citing works
File, T. M., Mandell, L. A., Tillotson, G. S., Kostov, K., & Georgiev, O. B. (2007) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkm119 · Cited by 68 · see citing works
Vaughn, V. M., Gandhi, T. N., Conlon, A., Chopra, V., Malani, A. N., & Flanders, S. A. (2018) · Clinical Infectious Diseases · doi:10.1093/cid/ciy1102 · Cited by 65 · see citing works
Self-citationGouliouris, T., Warne, B., Cartwright, E. J. P., Bedford, L., Weerasuriya, C. K., Raven, K. E., Brown, N. M., Török, M. E., Limmathurotsakul, D., & Peacock, S. J. (2018) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dky075 · Cited by 55 · see citing works
Madaras‐Kelly, K., Burk, M. L., Caplinger, C., et al. (2016) · Journal of Hospital Medicine · doi:10.1002/jhm.2648 · Cited by 45 · see citing works
Decreasing Duration of Antibiotic Prescribing for Uncomplicated Skin and Soft Tissue Infections
Schuler, C. L., Courter, J. D., Conneely, S. E., et al. (2016) · PEDIATRICS · doi:10.1542/peds.2015-1223 · Cited by 37 · see citing works
Haas, M. K., Dalton, K., Knepper, B. C., et al. (2016) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofw186 · Cited by 31 · see citing works
Grasela, T. H., Welage, L. S., Walawander, C. A., et al. (1990) · DICP · doi:10.1177/106002809002401215 · Cited by 22 · see citing works
Clostridium difficile: improving the prevention paradigm in healthcare settings
Vassallo, A., Tran, M.-C. N., & Goldstein, E. J. C. (2014) · Expert Review of Anti-infective Therapy · doi:10.1586/14787210.2014.942284 · Cited by 15 · see citing works
Sustained Impact of an Antibiotic Stewardship Intervention for Community-Acquired Pneumonia
Li, D. X., Ferrada, M. A., Avdic, E., et al. (2016) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2016.165 · Cited by 11 · see citing works
Reply to Azithromycin: Short Course with Long Duration
Royer, S., & Prescott, H. C. (2018) · Journal of Hospital Medicine · doi:10.12788/jhm.2983 · Cited by 6 · see citing works
Vaughn, V. M., & Flanders, S. A. (2016) · Annals of Internal Medicine · doi:10.7326/m16-2043 · Cited by 5 · see citing works
Self-citationDuration of Antibiotic Therapy for Community-Acquired Pneumonia in the Era of Personalized Medicine
Lee, J. S., Giesler, D. L., & Fine, M. J. (2016) · JAMA · doi:10.1001/jama.2016.17589 · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [28]Rubin DB. Multiple imputations in sample surveys – a phenomenological Bayesian approach to nonresponse. Proceedings of the Survey Research Methods section of the American Statistical Association. Alexandria, VA: American Statistical Association; 1978: 20– 34.
Cited by
Sorted by citations
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Vaughn, V. M., Gandhi, T. N., Petty, L. A., Patel, P. K., Prescott, H. C., Malani, A. N., Ratz, D., McLaughlin, E., Chopra, V., & Flanders, S. A. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1239 · Cited by 396 · see citing works
Self-citationRhee, C., Chiotos, K., Cosgrove, S. E., Heil, E. L., Kadri, S. S., Kalil, A. C., Gilbert, D. N., Masur, H., Septimus, E. J., Sweeney, D. A., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa059 · Cited by 191 · see citing works
Duration of antibiotic therapy: shorter is better
Spellberg, B., & Rice, L. B. (2019) · Annals of Internal Medicine · doi:10.7326/m19-1509 · Cited by 155 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
Choi, J. J., Westblade, L. F., Gottesdiener, L. S., Liang, K., Li, H. A., Wehmeyer, G. T., Glesby, M. J., & Simon, M. S. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab467 · Cited by 21 · see citing works
Israelsen, S. B., Fally, M., Tarp, B., Kolte, L., Ravn, P., & Benfield, T. (2023) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2022.08.004 · Cited by 15 · see citing works
Antibiotic De-escalation in adults hospitalized for community-onset Sepsis
Gupta, A. B., Heath, M., Walzl, E., Ratz, D., Munroe, E., Vaughn, V. M., Horowitz, J. K., Czilok, T., Petty, L. A., Gandhi, T. N., et al. (2026) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2025.6919 · Cited by 14 · see citing works
Self-citation
- Authors
- Vaughn, V. M., Flanders, S. A., Snyder, A., Conlon, A., Rogers, M. A. M., Malani, A. N., McLaughlin, E., Bloemers, S., Srinivasan, A., Nagel, J., Kaatz, S., Osterholzer, D., Thyagarajan, R., Hsaiky, L., Chopra, V., & Gandhi, T. N.
- Affiliations
- University of Michigan (US)
- Trinity Health Michigan (US)
- Centers for Disease Control and Prevention (US)
- Michigan Medicine (US)
- Henry Ford Hospital (US)
- Hurley Medical Center (US)
- Beaumont Hospital, Dearborn (US)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2019-08-06
- Volume
- 171
- Issue
- 3
- Pages
- 153-163
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC13258130
- OpenAlex
- W2956950695
- Semantic Scholar
- 030ea28f1e88e2a09d6b53ee120d7747f6236019
- Cited by
- 247
- References
- 43
- Citations by year
- 2026: 25 · 2025: 32 · 2024: 38 · 2023: 35 · 2022: 40 · 2021: 36 · 2020: 30 · 2019: 11
- FWCI
- 19.01
- Type
- journal article
- Language
- en
- Open access
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Annals of Internal Medicine
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- pneumonia, antibiotic stewardship, community-acquired pneumonia, healthcare-associated pneumonia, Clostridium difficile infection, hospital discharge documentation, length of hospital stay, patient-reported outcomes
- MeSH terms
- Duration of Therapy, Aged, Aged, 80 and over, Anti-Bacterial Agents, Female, Hospitalization, Humans, Male, Michigan, Middle Aged, Retrospective Studies, Community-Acquired Infections, Pneumonia, Bacterial, Inappropriate Prescribing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
