{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:45:00Z","timestamp":1790012700956,"version":"4.0.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T00:00:00Z","timestamp":1658880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Suspected pneumonia is the most common indication for antibiotics in hospitalized patients but is frequently overdiagnosed. We explored whether normal oxygenation could be used as an indicator to support early discontinuation of antibiotics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively identified all patients started on antibiotics for pneumonia in 4 hospitals with oxygen saturations \u226595% on ambient air, May 2017\u2013February 2021. We propensity-matched patients treated 1\u20132 days vs 5\u20138 days and compared hospital mortality and time to discharge using subdistribution hazard ratios (SHRs). Secondary outcomes included readmissions, 30-day mortality, Clostridioides difficile infections, hospital-free days, and antibiotic-free days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 39 752 patients treated for possible pneumonia, 10 012 had median oxygen saturations \u226595% without supplemental oxygen. Of these, 2871 were treated 1\u20132 days and 2891 for 5\u20138 days; 4478 patients were propensity-matched. Patients treated 1\u20132 vs 5\u20138 days had similar hospital mortality (2.1% vs 2.8%; SHR, 0.75 [95% confidence interval {CI}, .51\u20131.09]) but less time to discharge (6.1 vs 6.6 days; SHR, 1.13 [95% CI, 1.07\u20131.19]) and more 30-day hospital-free days (23.1 vs 22.7; mean difference, 0.44 [95% CI, .09\u2013.78]). There were no significant differences in 30-day readmissions (16.0% vs 15.8%; odds ratio [OR], 1.01 [95% CI, .86\u20131.19]), 30-day mortality (4.6% vs 5.1%; OR, 0.91 [95% CI, .69\u20131.19]), or 90-day C. difficile infections (1.3% vs 0.8%; OR, 1.67 [95% CI, .94\u20132.99]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>One-quarter of hospitalized patients treated for pneumonia had oxygenation saturations \u226595% on ambient air. Outcomes were similar with 1\u20132 vs 5\u20138 days of antibiotics. Normal oxygenation levels may help identify candidates for early antibiotic discontinuation. Prospective trials are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciac616","type":"journal-article","created":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T00:19:20Z","timestamp":1658881160000},"page":"e1217-e1223","source":"Crossref","is-referenced-by-count":7,"title":["Ultra-Short-Course Antibiotics for Suspected Pneumonia With Preserved Oxygenation"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8641-4498","authenticated-orcid":false,"given":"Michael","family":"Klompas","sequence":"first","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"McKenna","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aileen","family":"Ochoa","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi\u2019an Jiaotong University , Xi\u2019an, Shaanxi , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"},{"name":"Department of Epidemiology, Harvard T. 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Chan School of Public Health , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanu","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts , USA"},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Prevention Epicenters Program, Centers for Disease Control and Prevention","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,7,27]]},"reference":[{"key":"2023020817071270800_ciac616-B1","first-page":"194","article-title":"Vital signs: improving antibiotic use among hospitalized patients","volume":"63","author":"Fridkin","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023020817071270800_ciac616-B2","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1001\/jama.2014.12923","article-title":"Prevalence of antimicrobial use in US acute care hospitals, May\u2013September 2011","volume":"312","author":"Magill","year":"2014","journal-title":"JAMA"},{"key":"2023020817071270800_ciac616-B3","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.jhin.2018.03.038","article-title":"Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections?","volume":"99","author":"Cairns","year":"2018","journal-title":"J Hosp Infect"},{"key":"2023020817071270800_ciac616-B4","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1093\/cid\/ciaa373","article-title":"Antimicrobial use in US hospitals: comparison of results from emerging infections program prevalence surveys, 2015 and 2011","volume":"72","author":"Magill","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2023020817071270800_ciac616-B5","doi-asserted-by":"crossref","first-page":"e212007","DOI":"10.1001\/jamanetworkopen.2021.2007","article-title":"Assessment of the appropriateness of antimicrobial use in US hospitals","volume":"4","author":"Magill","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2023020817071270800_ciac616-B6","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1164\/rccm.201501-0017OC","article-title":"Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community-acquired pneumonia","volume":"192","author":"Claessens","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"2023020817071270800_ciac616-B7","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/j.1365-2559.2005.02243.x","article-title":"Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review","volume":"47","author":"Roulson","year":"2005","journal-title":"Histopathology"},{"key":"2023020817071270800_ciac616-B8","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1086\/675279","article-title":"Ventilator-associated pneumonia: overdiagnosis and treatment are common in medical and surgical intensive care units","volume":"35","author":"Nussenblatt","year":"2014","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2023020817071270800_ciac616-B9","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jcrc.2009.05.008","article-title":"Accuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings","volume":"25","author":"Tejerina","year":"2010","journal-title":"J Crit Care"},{"key":"2023020817071270800_ciac616-B10","doi-asserted-by":"crossref","first-page":"e2010700","DOI":"10.1001\/jamanetworkopen.2020.10700","article-title":"Prevalence of clinical signs within reference ranges among hospitalized patients prescribed antibiotics for pneumonia","volume":"3","author":"Klompas","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2023020817071270800_ciac616-B11","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1016\/j.chest.2020.06.034","article-title":"PROPHETIC: prospective identification of pneumonia in hospitalized patients in the ICU","volume":"158","author":"Bergin","year":"2020","journal-title":"Chest"},{"key":"2023020817071270800_ciac616-B12","doi-asserted-by":"crossref","first-page":"1702375","DOI":"10.1183\/13993003.02375-2017","article-title":"Low-dose computed tomography for the diagnosis of pneumonia in elderly patients: a prospective, interventional cohort study","volume":"51","author":"Prendki","year":"2018","journal-title":"Eur Respir J"},{"key":"2023020817071270800_ciac616-B13","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1001\/jama.1997.03550170070035","article-title":"Does this patient have community-acquired pneumonia? 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