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3-day Duration for Hospitalized Patients with Community-acquired Pneumonia: Results of a 68 Hospital Survey

Published online by Cambridge University Press:  23 June 2026

Valerie Vaughn
Affiliation:
University of Utah School of Medicine
Jennifer Horowitz
Affiliation:
DIvision of Hospital Medicine, Michigan Medicine
Ashwin Gupta
Affiliation:
University of Michgian/VA Ann Arbor Healthcare System
Tejal Gandhi
Affiliation:
University of Michigan Medical School
Lindsay Petty
Affiliation:
Michigan Medicine
Lisa Dumkow
Affiliation:
Trinity Health Grand Rapids
Anurag Malani
Affiliation:
Trinity Health Michigan
Preeti Misra
Affiliation:
Trinity Health Livonia Hospital
Robert Neetz
Affiliation:
MyMichigan Health
David Paje
Affiliation:
University of Michigan
Danielle Osterholzer
Affiliation:
Michigan State University College of Human Medicine
Mariam Younas
Affiliation:
Michigan State University - College of Human Medicine, Hurley Medical Center
Andrea White
Affiliation:
University of Utah School of Medicine
Tawny Czilok
Affiliation:
Michigan Medicine
Elizabeth McLaughlin
Affiliation:
Michigan Medicine
Scott Flanders
Affiliation:
Michigan Medicine
Julie Szymczak
Affiliation:
University of Utah School of Medicine

Abstract

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Background: The 2025 American Thoracic Society Community-acquired Pneumonia (CAP) guidelines conditionally recommend that patients hospitalized with non-severe CAP who reach clinical stability be treated with <5 days (3 day minimum) of antibiotics. To determine whether hospitals were implementing or planning to implement this recommendation, we surveyed 68 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). Methods: Hospitals participating in HMS completed an electronic survey in October and November of 2025. Abstractors were asked to answer (with stewardship team input) whether their hospital recommended (or planned to recommend) 3-day antibiotic treatment for any patients with CAP. If yes, they were asked a) which patient subgroups, b) whether their hospital guideline recommended 3 days, and c) what stewardship interventions they had implemented to increase 3-day durations. All hospitals were asked about barriers. Results: All hospitals (68/68) responded to the survey; 21% (14) reported they currently recommend a 3-day duration for at least some patients with CAP; another 18% (12) do not but are planning to. Hospital characteristics by response category are shown in Figure 1. Of hospitals already recommending or planning to recommend a 3-day duration, 31% (8) recommend it (or plan to) in all patients with CAP. Among the 18 hospitals recommending/planning to recommend a 3-day duration for only a subset of patients, commonly stated criteria were: clinical stability (55%), non-severe CAP (33%), or uncomplicated CAP (33%). Most hospitals (79%) recommending a 3-day duration included the 3-day recommendation in their CAP guideline and 71% reported at least one stewardship intervention in place to increase use of 3-day durations (10, education; 3, audit and feedback; 2, pharmacist bundle; 1, orderset; 1, discharge-specific intervention). Commonly reported barriers or reasons for not recommending a 3-day duration included: focus on 5-day duration (31%), resource/time limitation (14%), EHR transition (12%), and inability to recommend a 3-day duration unless the entire healthcare system did (10%). Notably, 7% expressed confusion about IDSA endorsement of the ATS guidelines (IDSA endorsed the <5 day duration but not the viral pneumonia recommendation). Conclusion: Just over a third (38%) of Michigan hospitals currently recommend or plan to recommend a 3-day antibiotic duration for at least some hospitalized patients with CAP. For the remaining 62% of hospitals, continued focus on 5-day duration, standard barriers around stewardship infrastructure, and concerns about existing evidence, safety, and guidance limit enthusiasm for a 3-day duration.

A table comparing hospital characteristics and their recommendations for a 3-day antibiotic duration for some patients with CAP.

Information

Type
Antibiotic Stewardship
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America