Treatment of hospital-acquired pneumonia – Authors' Reply

Michael Niederman and colleagues raise concerns regarding our multicentre effort to implement American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) guidelines for treatment of health-care-associated, hospital-acquired, and ventilator-associated pneumonias.1 Specifically, in patients at risk for multidrug-resistant pathogens, we reported that empirical antibiotic therapy conforming to guidelines was associated with increased mortality unexplained by patients' acuity or chronic conditions. [...]among all empirically treated patients, the point estimate for mortality risk was higher with dual Gram-negative therapy than with non-compliant therapy. IMPACT-HAP's results argue for future studies addressing if and when dual Gram-negative therapy should be prescribed for patients with pneumonia patients at risk of multidrug-resistant pathogens.