{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:26:54Z","timestamp":1791379614680,"version":"4.3.3"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nursing and healthcare\u2010associated pneumonia (NHCAP) is defined as pneumonia occurring in individuals with frequent healthcare contact, such as residents of care facilities or patients with impaired activities of daily living. The effectiveness of broad\u2010spectrum antibiotics in treating NHCAP remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare clinical outcomes between broad\u2010 and narrow\u2010spectrum antibiotic treatments in patients with NHCAP using a nationwide inpatient database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients diagnosed with NHCAP between April 2014 and March 2022 were identified from the Diagnosis Procedure Combination inpatient database in Japan. Patients were categorised into those receiving broad\u2010spectrum antibiotics (antipseudomonal penicillins, antipseudomonal cephalosporins, and carbapenems) and those receiving narrow\u2010spectrum antibiotics (third\u2010generation cephalosporins and penicillin plus \u03b2\u2010lactamase inhibitor combinations). Instrumental variable analysis using hospital preference for broad\u2010spectrum antibiotics was conducted to compare 30\u2010day in\u2010hospital mortality. A subgroup analysis was performed for patients with \u22653 risk factors for antibiotic\u2010resistant pathogens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 828,283 eligible patients, 24.8% received broad\u2010spectrum antibiotics, while 75.2% received narrow\u2010spectrum antibiotics. Instrumental variable analysis showed that broad\u2010spectrum antibiotic use was not associated with 30\u2010day in\u2010hospital mortality (10.0% vs. 10.0%; risk difference, 0.0%; 95% confidence interval, \u22120.7% to 0.8%) compared with narrow\u2010spectrum antibiotic use. The subgroup analysis of patients with three or more risk factors for antibiotic\u2010resistant pathogens, broad\u2010spectrum antibiotic use was also not associated with 30\u2010day mortality (10.5% vs. 11.0%; risk difference, \u22120.6%; 95% confidence interval, \u22122.5% to 1.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Broad\u2010spectrum antibiotic use was not associated with short\u2010term in\u2010hospital mortality in patients with NHCAP, underscoring the importance of individualized antibiotic selection based on patient\u2010specific risk factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70195","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T21:19:57Z","timestamp":1759958397000},"page":"477-486","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Mortality after broad\u2010 versus narrow\u2010spectrum antibiotic treatment for patients with nursing and healthcare\u2010associated pneumonia: A nationwide retrospective cohort study"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2480-9018","authenticated-orcid":false,"given":"Jumpei","family":"Taniguchi","sequence":"first","affiliation":[{"name":"Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo 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