Clin Infect Dis

Do immunocompromised pneumonia patients need broad-spectrum antibiotics?

September 11, 2025

Study details: This target trial emulation evaluated the impact of empiric broad-spectrum antibiotics (BSAs) on clinical outcomes in 2,706 moderately immunocompromised adults hospitalized with community-acquired pneumonia and no risk factors for multidrug-resistant organisms (MDROs). Immunocompromising conditions included asplenia, hematologic or solid organ malignancies, and long-term immunosuppressive therapy. Patients were treated empirically with either broad-spectrum antibiotics or agents targeting typical respiratory pathogens within the first two hospital days. The primary outcome was mortality; secondary outcomes included ICU transfer, length of stay, 30-day readmission, and antibiotic-associated adverse events.

Results: Empiric BSAs were administered to 59% of patients, yet MDROs were rare (3.5%). After adjustment, broad-spectrum therapy wasn’t associated with reduced mortality. However, it was associated with increased risk of 30-day readmission (adjusted hazard ratio [aHR], 1.32), ICU transfer (aHR, 2.65), and longer hospitalization (adjusted rate ratio, 1.14).

Clinical impact: In moderately immunocompromised patients without MDRO risk factors, empiric BSAs appear to confer no mortality benefit and are associated with increased harm, supporting stewardship efforts to limit BSA use in this population.

Source:

Saravolatz L, et al. (2025, July 2). Clin Infect Dis. Target Trial Emulation of Empiric Antibiotics on Clinical Outcomes in Moderately Immunocompromised Patients Hospitalized with Pneumonia. https://pubmed.ncbi.nlm.nih.gov/40601818/