Effectiveness of Fluoroquinolone De-escalation in Community-Acquired Pneumonia: Impact on Hospital Stay and Mortality

Objective: This study aimed to evaluate the effectiveness of fluoroquinolone de-escalation in adult patients with community-acquired pneumonia (CAP), examining its impact on hospital length of stay (LOS), mortality, and association with microbial culture results. Methods: A retrospective cohort study was conducted on adult patients diagnosed with CAP at a tertiary hospital in Jordan. The study analyzed fluoroquinolone de-escalation outcomes, including hospital LOS and mortality, as well as the relationship between microbial culture results and de-escalation success. Results: The study sample consisted of 125 patients, with a median age of 73 years (IQR = 24). Of these, 64.8% (n=81) were male, and 35.2% (n=44) were female. Fluoroquinolone therapy was predominantly levofloxacin (99.2%, n=124). Fluoroquinolone de-escalation was successfully achieved in 33.6% (n=42) of patients. Positive culture results significantly increased de-escalation success, as 61.5% (n=16) of patients with positive cultures successfully de-escalating compared to 26.0% (n=25) of those with negative cultures (p = 0.002). Among patients with negative cultures (n=96), 43.8% (n=42) underwent inappropriate de-escalation, and 30.2% (n=29) had failed de-escalation. Patients in the successfully de-escalated group had a significantly shorter median hospital stay of 12 days (IQR = 8) compared to 18 days (IQR = 11) in the failed/inappropriate group (p = 0.004). There was no significant difference in mortality between the two groups, with 70.1% (n=29) surviving in the successfully de-escalated group versus 76.5% (n=62) in the other group (p = 0.514). Conclusion: Fluoroquinolone de-escalation in CAP patients is linked to shorter hospital stays without affecting mortality. Positive culture results significantly increase de-escalation success, supporting the need for improved de-escalation protocols.