Should Patients Hospitalized for Community-Acquired Pneumonia Be Treated With Additional Antimicrobial Agents Directed Against Anaerobes?
Bibliographic record
Abstract
BACKGROUND: The revised 2019 American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) clinical practice guidelines for treatment of community-acquired pneumonia (CAP) in newly hospitalized patients with no immunocompromising condition do not recommend addition of focused anaerobic coverage in the absence of lung abscess or empyema. However, many clinicians still prescribe antimicrobial treatment of anaerobes. Our article reviews the basis for the ATS/IDSA guidelines and provides recommendations based on more recent evidence. AREAS OF UNCERTAINTY: Despite the ATS/IDSA 2019 guidelines for treatment of newly hospitalized patients with CAP, clinicians still prescribe directed anaerobic treatment. We include newer data since the publication of the CAP guidelines to determine if the recommendations should be revised. DATA SOURCES: The databases searched for this review included PubMed/MEDLINE, Google Scholar, CINAHL, Embase, and Cochrane Library, using controlled vocabulary including the following medical subject headings keywords: aspiration, pneumonia, anaerobe, and anaerobic coverage. Studies and reviews from January 2019 to June 2024 were evaluated. Articles were selected if the content involved treatment, including clinical outcomes and microbiology. THERAPEUTIC ADVANCES: We found 4 articles between 2019 and 2024 addressing the 2019 ATS/IDSA CAP guidelines. One Canadian study comparing patients receiving limited or extended anaerobic coverage found no significant mortality benefit and a significantly higher rate of Clostridioides difficile colitis with extended coverage. Another study demonstrated a longer intensive care unit length of stay in patients receiving additional anaerobic coverage. A systematic review and meta-analysis also demonstrated no mortality benefit in patients with aspiration pneumonia who received directed anaerobic coverage versus those who did not. In another study, the prevalence of anaerobic bacteria isolated from respiratory samples was similar in patients with aspiration community–acquired pneumonia versus patients with CAP with or without aspiration risk factors. CONCLUSIONS: Based on review of newer evidence, we continue to support the 2019 ATS/IDSA treatment guidelines for CAP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".