# Guideline-concordant antibiotic prescribing for community-acquired bacterial pneumonia (CABP) due to drug-resistant pathogens in the All of Us database

## TL;DR

This study examines how often doctors prescribe recommended antibiotics for pneumonia caused by drug-resistant bacteria in a large health database.

## Contribution

The study identifies racial disparities in antibiotic prescribing for CABP-P. aeruginosa in a diverse patient database.

## Key findings

- 70% of CABP-MRSA patients received guideline-concordant antibiotics.
- Non-Hispanic Black patients were less likely to receive guideline-concordant therapy for CABP-P. aeruginosa.
- Race was a significant predictor of guideline-concordant antibiotic use for CABP-P. aeruginosa but not CABP-MRSA.

## Abstract

Community-acquired bacterial pneumonia (CABP) contributes significantly to mortality and healthcare costs worldwide. The use of guideline-concordant antibiotic therapy for CABP is associated with improved outcomes.

This was a retrospective cohort study of inpatients with CABP due to MRSA or P. aeruginosa in the All of Us database. The proportion of patients on guideline-concordant antibiotics or guideline-discordant antibiotics was compared within groups based upon patient age, sex, self-reported race, ethnicity, marital status, alcohol use, and tobacco use. Guideline concordance was determined using the 2019 IDSA/ATS CABP guidelines. Associations were further analyzed using multivariate logistic regression.

A total of 336 patients with CABP due to MRSA (152) or P. aeruginosa (184) were included. Guideline-concordant antibiotic therapy was prescribed to 70% of CABP-MRSA patients and for 57% of CABP-P. aeruginosa patients. Independently predictive factors of guideline-concordant antibiotic prescribing for CABP-P. aeruginosa patients were Non-Hispanic Black (NHB) vs. Non-Hispanic White (NHW) race (odds ratio = 0.30, 95% confidence interval = 0.12 – 0.75).

In the All of Us database, the majority of CABP-MRSA and CABP-P. aeruginosa patients were prescribed guideline-concordant antibiotic therapy. Race was independently predictive of guideline-concordant antibiotic therapy for patients with CABP-P. aeruginosa, but not CABP-MRSA. NHB patients were less likely to receive guideline-concordant antibiotic therapy than NHW patients when treated for CABP-P. aeruginosa.