Antibiotics with extended anaerobic coverage are used commonly to treat aspiration pneumonia, which is not recommended by current guidelines. In patients admitted to hospital for community-acquired aspiration pneumonia, does a difference exist between antibiotic therapy with limited anaerobic coverage (LAC) vs antibiotic therapy with extended anaerobic coverage (EAC) in terms of in-hospital mortality and risk of colitis? We conducted a multicenter retrospective cohort study across 18 hospitals in Ontario, Canada, from January 1, 2015, to January 1, 2022. Patients were included if the physician diagnosed aspiration pneumonia and prescribed guideline-concordant first-line community-acquired pneumonia parenteral antibiotic therapy to the patient within 48 h of admission. Patients then were categorized into the LAC group if they received ceftriaxone, cefotaxime, or levofloxacin. Patients were categorized into the EAC group if they received amoxicillin-clavulanate, moxifloxacin, or any of ceftriaxone, cefotaxime, or levofloxacin in combination with clindamycin or metronidazole. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included incident colitis occurring after admission. Overlap weighting of propensity scores was used to balance baseline prognostic factors. The LAC and EAC groups included 2,683 and 1,316 patients, respectively. In hospital, 814 patients (30.3%) and 422 patients (32.1%) in the LAC and EAC groups died, respectively. colitis occurred in five or fewer patients (≤ 0.2%) and 11 to 15 patients (0.8%-1.1%) in the LAC and EAC groups, respectively. After overlap weighting of propensity scores, the adjusted risk difference of EAC minus LAC was 1.6% (95% CI, –1.7% to 4.9%) for in-hospital mortality and 1.0% (95% CI, 0.3%-1.7%) for colitis. Extended anaerobic coverage likely is unnecessary in aspiration pneumonia because it is associated with no additional mortality benefit, only an increased risk of colitis.

中文翻译：

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吸入性肺炎中厌氧抗生素的覆盖率及其相关的利弊：一项回顾性队列研究

具有扩大厌氧菌覆盖范围的抗生素通常用于治疗吸入性肺炎，但当前指南不推荐这样做。对于因社区获得性吸入性肺炎入院的患者，有限厌氧菌覆盖（LAC）抗生素治疗与扩大厌氧菌覆盖（EAC）抗生素治疗在院内死亡率和结肠炎风险方面是否存在差异？我们于 2015 年 1 月 1 日至 2022 年 1 月 1 日在加拿大安大略省的 18 家医院进行了一项多中心回顾性队列研究。如果医生诊断出吸入性肺炎并开出符合指南的一线社区获得性肺炎肠外抗生素，则患者被纳入研究。患者入院后 48 小时内接受治疗。如果患者接受头孢曲松、头孢噻肟或左氧氟沙星治疗，则被分为 LAC 组。如果患者接受阿莫西林克拉维酸、莫西沙星或头孢曲松、头孢噻肟或左氧氟沙星中的任何一种联合克林霉素或甲硝唑治疗，则患者被分为 EAC 组。主要结局是全因住院死亡率。次要结局包括入院后发生的结肠炎。倾向评分的重叠加权用于平衡基线预后因素。LAC 组和 EAC 组分别包括 2,683 名患者和 1,316 名患者。在院内，LAC 组和 EAC 组分别有 814 名患者（30.3%）和 422 名患者（32.1%）死亡。LAC 组和 EAC 组分别有 5 名或更少患者（≤ 0.2%）和 11 至 15 名患者（0.8%-1.1%）发生结肠炎。对倾向评分进行重叠加权后，EAC 减去 LAC 的调整后院内死亡率风险差异为 1.6%（95% CI，–1.7% 至 4.9%），院内死亡风险差异为 1.0%（95% CI，0.3%-1.7%）。结肠炎。对于吸入性肺炎，扩大厌氧覆盖范围可能是不必要的，因为它不会带来额外的死亡率益处，只会增加结肠炎的风险。