Amoxicillin/clavulanate activity against bacteria isolated in severe community-acquired pneumonia: a retrospective study (sCAP).

BACKGROUND

Severe community-acquired pneumonia (sCAP) requires prompt empirical antibiotic therapy. Amoxicillin-clavulanate (AMC), an "Access" antibiotic per WHO AWaRe classification, could possibly constitute an ecologically preferable alternative to third-generation cephalosporins (3GCs).

OBJECTIVES

To assess AMC susceptibility in bacterial isolates from sCAP patients and to identify factors associated with AMC resistance.

METHODS

A retrospective single-center study was conducted between 2019 and 2021 in a single ICU. Patients with sCAP and positive respiratory cultures within 48 h were included.

RESULTS

In 185 patients, 212 isolates were identified. AMC susceptibility was 83.5 % overall, with the highest rates for S. pneumoniae (97.9 %), H. influenzae (84.6 %), and S. aureus (96.1 %). Prior antibiotic use within three months was the only independent factor associated with AMC resistance (p < 0.00001). Susceptibility reached 90.9 % in patients without prior antibiotic use.

CONCLUSION

AMC is a viable empirical option for sCAP treatment in patients without recent antibiotic exposure, offering more pronounced ecological benefits than 3GCs.