{"doi":"10.1093/cid/ciaa1604","title":"Simulated Adoption of 2019 Community-Acquired Pneumonia Guidelines Across 114 Veterans Affairs Medical Centers: Estimated Impact on Culturing and Antibiotic Selection in Hospitalized Patients","abstract":"BACKGROUND: The 2019 American Thoracic Society/Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) revised recommendations for culturing and empiric broad-spectrum antibiotics. We simulated guideline adoption in Veterans Affairs (VA) inpatients. METHODS: For all VA acute hospitalizations for CAP from 2006-2016 nationwide, we compared observed with guideline-expected proportions of hospitalizations with initial blood and respiratory cultures obtained, empiric antibiotic therapy with activity against methicillin-resistant Staphylococcus aureus (anti-MRSA) or Pseudomonas aeruginosa (antipseudomonal), empiric \"overcoverage\" (receipt of anti-MRSA/antipseudomonal therapy without eventual detection of MRSA/P. aeruginosa on culture), and empiric \"undercoverage\" (lack of anti-MRSA/antipseudomonal therapy with eventual detection on culture). RESULTS: Of 115 036 CAP hospitalizations over 11 years, 17 877 (16%) were admitted to an intensive care unit (ICU). Guideline adoption would slightly increase respiratory culture (30% to 36%) and decrease blood culture proportions (93% to 36%) in hospital wards and increase both respiratory (40% to 100%) and blood (95% to 100%) cultures in ICUs. Adoption would decrease empiric selection of anti-MRSA (ward: 27% to 1%; ICU: 61% to 8%) and antipseudomonal (ward: 25% to 1%; ICU: 54% to 9%) therapies. This would correspond to greatly decreased MRSA overcoverage (ward: 27% to 1%; ICU: 56% to 8%), slightly increased MRSA undercoverage (ward: 0.6% to 1.3%; ICU: 0.5% to 3.3%), with similar findings for P. aeruginosa. For all comparisons, P < .001. CONCLUSIONS: Adoption of the 2019 CAP guidelines in this population would substantially change culturing and empiric antibiotic selection practices, with a decrease in overcoverage and slight increase in undercoverage for MRSA and P. aeruginosa.","journal":"Clinical Infectious Diseases","year":2020,"id":107792,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6141,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":518379,"name":"McKenna Nevers","orcid":null,"position":1,"is_corresponding":false},{"id":517589,"name":"Ying Jian","orcid":"0000-0001-5185-2455","position":2,"is_corresponding":false},{"id":518380,"name":"Candace Haroldsen","orcid":null,"position":3,"is_corresponding":false},{"id":317408,"name":"Vanessa Stevens","orcid":"0000-0001-8933-5453","position":4,"is_corresponding":false},{"id":517590,"name":"Makoto Jones","orcid":"0000-0001-5580-6739","position":5,"is_corresponding":false},{"id":518381,"name":"Peter M. Yarbrough","orcid":null,"position":6,"is_corresponding":false},{"id":396978,"name":"Matthew Bidwell Goetz","orcid":"0000-0003-4542-992X","position":7,"is_corresponding":false},{"id":371692,"name":"Marcos I. Restrepo","orcid":"0000-0001-9107-3405","position":8,"is_corresponding":false},{"id":518382,"name":"Karl Madaras‐Kelly","orcid":null,"position":9,"is_corresponding":false},{"id":237134,"name":"Matthew H. Samore","orcid":"0000-0002-4862-9196","position":10,"is_corresponding":false},{"id":517591,"name":"Barbara Jones","orcid":"0000-0002-0971-6887","position":11,"is_corresponding":false},{"id":517588,"name":"Matthew A. Christensen","orcid":"0000-0002-6021-8680","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-18T23:12:39.385256Z","pmid":"33512530","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}