J. Pharm. Pharmacogn. Res., vol. 14, no. 5, Article ID 2801, Sep-Oct 2026.

DOI: https://doi.org/10.56499/jppres_14.5.2801

Original Article

Antimicrobial treatment appropriateness and clinical outcomes in adults hospitalized with community-acquired pneumonia in Cartagena, 2021

[Pertinencia del tratamiento antimicrobiano y desenlaces clínicos en adultos hospitalizados con neumonía adquirida en la comunidad en Cartagena 2021]

Sergio L. Uribe Merlano^1,2,3*, Nelson R. Alvis Guzmán⁴, Antistio A. Alviz Amador^1,2

¹Faculty of Pharmaceutical Sciences, University of Cartagena, Cartagena de Indias, Colombia.

²PhD Program in Biomedical Sciences, University of Cartagena, Cartagena de Indias, Colombia.

³GENOMA Research Group, University of Sinú – Elías Bechara Zainúm, Cartagena Campus, Cartagena, Colombia.

⁴Health Economics Research Group, Faculty of Economics, University of Cartagena, Cartagena, Colombia.

*E-mail: suribem@unicartagena.edu.co

Abstract

Context: Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and antibiotic use in adults. Appropriate selection of initial empirical therapy is a central component of clinical management, particularly in settings where microbiological confirmation is not always available.

Aims: To evaluate the appropriateness of initial empirical antibiotic therapy and its association with clinical outcomes in adults hospitalized with CAP at a tertiary-care (high-complexity) hospital in Cartagena de Indias during 2021.

Methods: A retrospective observational cohort study was conducted using medical records and microbiological reports. The appropriateness of the initial empirical antibiotic therapy prescribed at admission or within the first 24 hours was assessed according to institutional guidelines based on ATS/IDSA recommendations and the local microbiological profile. Outcomes included in-hospital mortality, ICU admission, hospital length of stay, and 30-day readmission. Associations were analyzed using multivariable models and inverse probability of treatment weighting (IPTW), with covariate balance assessment.

Results: A total of 785 patients were included, with a mean age of 66 ± 19 years. An etiological diagnosis was documented in 61.0% of cases, with Streptococcus pneumoniae being the most frequently identified microorganism. Initial empirical antibiotic therapy was classified as appropriate in 526 patients (67.0%) and was statistically associated with lower in-hospital mortality, lower frequency of ICU admission, shorter hospital stay, and lower 30-day readmission.

Conclusions: Appropriate initial empirical antibiotic therapy was statistically associated with more favorable clinical outcomes in adults hospitalized with CAP. These findings are consistent with the importance of adherence to clinical practice guidelines, disease severity assessment, microbiological support, and institutional antimicrobial stewardship strategies.

Keywords: antibacterial agents; antimicrobial stewardship; cohort studies; community-acquired pneumonia; guideline adherence.

Resumen

Contexto: La neumonía adquirida en la comunidad (NAC) es una causa frecuente de hospitalización y uso de antibióticos en adultos. La selección adecuada del tratamiento empírico inicial es un componente central del manejo clínico, especialmente cuando la confirmación microbiológica no está disponible.

Objetivos: Evaluar la pertinencia del tratamiento antibiótico empírico inicial y su asociación con desenlaces clínicos en adultos hospitalizados con NAC en un hospital de atención terciaria (alta complejidad) de Cartagena de Indias durante 2021.

Métodos: Se realizó un estudio observacional retrospectivo de cohorte basado en historias clínicas y reportes microbiológicos. La pertinencia del tratamiento antibiótico empírico inicial, prescrito al ingreso o durante las primeras 24 horas, se evaluó según las guías institucionales basadas en las recomendaciones ATS/IDSA y el perfil microbiológico local. Los desenlaces incluyeron mortalidad intrahospitalaria, ingreso a UCI, estancia hospitalaria y reingreso a 30 días. Las asociaciones se analizaron mediante modelos multivariados y ponderación por probabilidad inversa del tratamiento (IPTW), con evaluación del balance de covariables.

Resultados: Se incluyeron 785 pacientes, con edad promedio de 66 ± 19 años. En el 61,0% de los casos hubo diagnóstico etiológico, siendo Streptococcus pneumoniae el microorganismo más identificado. El tratamiento antibiótico empírico inicial fue clasificado como pertinente en 526 pacientes (67,0%) y se asoció estadísticamente con menor mortalidad intrahospitalaria, menor frecuencia de ingreso a UCI, menor estancia hospitalaria y menor reingreso a 30 días.

Conclusiones: La pertinencia del tratamiento antibiótico empírico inicial se asoció con desenlaces clínicos más favorables en adultos hospitalizados con NAC. Estos hallazgos son consistentes con la importancia de la adherencia a guías de práctica clínica, la evaluación de la severidad de la enfermedad, el soporte microbiológico y las estrategias institucionales de optimización antimicrobiana.

Palabras Clave: adherencia a guías; agentes antibacterianos; estudios de cohorte; neumonía adquirida en la comunidad; programas de optimización de antimicrobianos.

https://jppres.com/jppres/pdf/vol14/jppres_14.5.2801.pdf

Citation Format: Uribe Merlano SL, Alvis Guzmán NR, Alviz Amador AA (2026) Antimicrobial treatment appropriateness and clinical outcomes in adults hospitalized with community-acquired pneumonia in Cartagena, 2021. J Pharm Pharmacogn Res 15(5): 2801. https://doi.org/10.56499/jppres_14.5.2801

References

Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI (2021) Community-acquired pneumonia. Lancet 398(10303): 906–919. https://doi.org/10.1016/S0140-6736(21)00630-9

Al-Tawfiq JA, Momattin H, Hinedi K (2019) Empiric antibiotic therapy in the treatment of community-acquired pneumonia in a general hospital in Saudi Arabia. J Glob Infect Dis 11(2): 69–72. https://doi.org/10.4103/jgid.jgid_84_18

Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46(3): 399–424. https://doi.org/10.1080/00273171.2011.568786

Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34(28): 3661–3679. https://doi.org/10.1002/sim.6607

Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK (2016) Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 62(10): e51–e77. https://doi.org/10.1093/cid/ciw118

Ferreira-Coimbra J, Sarda C, Rello J (2020) Burden of community-acquired pneumonia and unmet clinical needs. Adv Ther 37(4): 1302–1318. https://doi.org/10.1007/s12325-020-01248-7

Gadsby NJ, Musher DM (2022) The microbial etiology of community-acquired pneumonia in adults. Clin Microbiol Rev 35(4): e00015-22. https://doi.org/10.1128/cmr.00015-22

Hosmer DW, Lemeshow S, Sturdivant RX (2013) Applied Logistic Regression. 3rd ed. Hoboken, NJ: Wiley. https://doi.org/10.1002/9781118548387

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG (2019) Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 200(7): e45–e67. https://doi.org/10.1164/rccm.201908-1581ST

Musher DM, Thorner AR (2014) Community-acquired pneumonia. N Engl J Med 371(17): 1619–1628. https://doi.org/10.1056/NEJMra1312885

Oliveira e Silva PG, Cerqueira Batista Filho LA, Pérez Flores I, Vilins e Silva V, Toledo Maciel A, Seraphim Medeiros L (2023) Community-acquired pneumonia: Epidemiology, diagnosis, prognostic severity scales, and new therapeutic options. Medwave 23(11): e2719. https://doi.org/10.5867/medwave.2023.11.2719

Rossio R, Franchi C, Ardoino I, Djade CD, Tettamanti M, Pasina L, Salerno F, Marengoni A, Corrao S, Marcucci M, Peyvandi F, Biganzoli EM, Nobili A, Mannucci PM; REPOSI Investigators (2015) Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia. Eur J Intern Med 26(5): 330–337. https://doi.org/10.1016/j.ejim.2015.04.002

Sakamoto Y, Yamauchi Y, Yasunaga H, Takeshima H, Hasegawa W, Jo T, Matsui H, Fushimi K, Nagase T (2017) Guidelines-concordant empiric antimicrobial therapy and mortality in patients with severe community-acquired pneumonia requiring mechanical ventilation. Respir Investig 55(1): 39–44. https://doi.org/10.1016/j.resinv.2016.08.006

Schuts EC, Hulscher MEJL, Mouton JW, Verduin CM, Stuart JWTC, Overdiek HWPM, van der Linden PD, Natsch S, Hertogh CMPM, Wolfs TFW, Schouten JA, Kullberg BJ, Prins JM (2016) Current evidence on hospital antimicrobial stewardship objectives: A systematic review and meta-analysis. Lancet Infect Dis 16(7): 847–856. https://doi.org/10.1016/S1473-3099(16)00065-7

Tamma PD, Miller MA, Cosgrove SE (2019) Rethinking how antibiotics are prescribed: Incorporating the 4 moments of antibiotic decision making into clinical practice. JAMA 321(2): 139-140. https://doi.org/10.1001/jama.2018.19509

Tomczyk S, Jain S, Bramley AM, Self WH, Anderson EJ, Trabue C, Courtney DM, Grijalva CG, Waterer GW, Edwards KM, Wunderink RG, Hicks LA (2017) Antibiotic prescribing for adults hospitalized in the Etiology of Pneumonia in the Community Study. Open Forum Infect Dis 4(3): ofx088. https://doi.org/10.1093/ofid/ofx088

Uribe Merlano S, Alvis Guzmán N, Alviz Amador A, Caraballo Marimón R, Yepes Terril A (2025) Pertinence of antimicrobial prescriptions in the management of community-acquired pneumonia in Cartagena, Colombia, 2021. Universitas Scientiarum 30(Suppl): S23. https://doi.org/10.11144/Javeriana.SCSI30.poap

Vaughn VM, Dickson RP, Horowitz JK, Flanders SA (2024) Community-acquired pneumonia: A review. JAMA 332(15): 1282–1295. https://doi.org/10.1001/jama.2024.14796

Viasus D, Vecino-Moreno M, De La Hoz JM, Carratalà J (2017) Antibiotic stewardship in community-acquired pneumonia. Expert Rev Anti Infect Ther 15(4): 351–359. https://doi.org/10.1080/14787210.2017.1274232

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 12(12): 1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013

Xie F, Duan Z, Zeng W, Xie S, Xie M, Fu H, Ye Q, Xu T, Xie L (2021) Clinical metagenomics assessments improve diagnosis and outcomes in community-acquired pneumonia. BMC Infect Dis 21: 352. https://doi.org/10.1186/s12879-021-06039-1

© 2026 Journal of Pharmacy & Pharmacognosy Research