Exploration of Medicine

Table 2. Isolated bacterial pathogens, fluoroquinolone resistance profiles, and antibiotic de-escalation outcomes among patients with suspected CAP and positive cultures (n = 29).

Patient No.	Specimen type	Bacteria name	Resistance pattern to fluoroquinolones	De-escalation outcome
1	Blood specimen	Viridans group streptococci	Resistant to levofloxacin	Successfully de-escalated
2	Sputum specimen	Streptococcus pyogenes (Group A)	Resistant to levofloxacin	Successfully de-escalated
3	Blood specimen	Staphylococcus species Coagulase	Resistant to levofloxacin	Successfully de-escalated
4	Blood specimen	Staphylococcus species Coagulase	Resistant to levofloxacin	Successfully de-escalated
5	Blood specimen	Staphylococcus species Coagulase	NA	Incorrectly de-escalated
6	Blood specimen	Staphylococcus species Coagulase	Resistant to levofloxacin	Failed de-escalation
7	Blood specimen	Staphylococcus hominis	Resistant to levofloxacin	Successfully de-escalated
8	Blood specimen	Staphylococcus hominis	Resistant to levofloxacin	Failed de-escalation
9	Blood specimen	Staphylococcus hominis	NA	Successfully de-escalated
10	Blood specimen	Staphylococcus hominis	Resistant to levofloxacin	Failed de-escalation
11	Blood specimen	Staphylococcus hominis	Resistant to levofloxacin	Failed de-escalation
12	Blood specimen	Staphylococcus hominis	Resistant to levofloxacin	Failed de-escalation
13	Blood specimen	Staphylococcus haemolyticus	Resistant to levofloxacin	Successfully de-escalated
14	Blood specimen	Staphylococcus haemolyticus	Sensitive to levofloxacin	Successfully de-escalated
15	Blood specimen	Staphylococcus epidermidis	NA	Incorrectly de-escalated
16	Blood specimen	Staphylococcus epidermidis	Sensitive to levofloxacin	Failed de-escalation
17	Blood specimen	Staphylococcus epidermidis	Sensitive to levofloxacin	Failed de-escalation
18	Blood specimen	Staphylococcus aureus	Resistant to levofloxacin	Incorrectly de-escalated
19	Sputum specimen	Klebsiella pneumoniae	Resistant to levofloxacin	Successfully de-escalated
20	Blood specimen	Klebsiella pneumoniae	Resistant to levofloxacin	Successfully de-escalated
21	Blood specimen	Klebsiella pneumoniae	Resistant to levofloxacin	Successfully de-escalated
22	Blood specimen	Klebsiella pneumoniae	Resistant to levofloxacin	Successfully de-escalated
23	Blood specimen	Klebsiella pneumoniae and Staphylococcus aureus	Resistant to levofloxacin	Failed de-escalation
24	Blood specimen	Escherichia coli	Resistant to levofloxacin	Successfully de-escalated
25	Sputum specimen	Escherichia coli	Resistant to ciprofloxacin	Successfully de-escalated
26	Blood specimen	Diphtheroids bacilli	Resistant to levofloxacin	Successfully de-escalated
27	Blood specimen	Diphtheroids bacilli	Resistant to levofloxacin	Failed de-escalation
28	Sputum specimen	Acinetobacter baumannii	Resistant to ciprofloxacin	Successfully de-escalated
29	Blood specimen	Acinetobacter baumannii	Resistant to levofloxacin	Failed de-escalation

Return to article view

CAP: community-acquired pneumonia.

Declarations

Author contributions

AAA: Conceptualization, Methodology, Writing—original draft, Writing—review & editing, Data curation. KAH: Conceptualization, Methodology, Writing—original draft, Writing—review & editing, Data curation. AA: Conceptualization, Methodology, Writing—original draft, Writing—review & editing. MZ: Conceptualization, Methodology, Writing—original draft, Writing—review & editing. RKAF: Conceptualization, Methodology, Writing—original draft, Writing—review & editing, Data curation. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that there are no conflicts of interest.

Ethical approval

The study was conducted in accordance with the principles outlined in the World Medical Association Declaration of Helsinki. It received approval from the JUH Institutional Review Board (approval number 10/2024/1389).

Consent to participate

To ensure patient confidentiality, all data were de-identified and anonymized. Given the retrospective, observational design, the ethical committee granted a waiver for informed consent.

Consent to publication

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Funding

This study did not receive any funding support.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

File TM Jr, Ramirez JA. Community-Acquired Pneumonia. N Engl J Med. 2023;389:632–41. [DOI] [PubMed]

who.int [Internet]. [cited 2025 Dec 15]. Available from: https://www.who.int/

Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al.; CDC EPIC Study Team. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015;373:415–27. [DOI] [PubMed] [PMC]

Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109:309–18. [DOI] [PubMed] [PMC]

Shrestha P, Cooper BS, Coast J, Oppong R, Do Thi Thuy N, Phodha T, et al. Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Antimicrob Resist Infect Control. 2018;7:98. [DOI] [PubMed] [PMC]

Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS One. 2017;12:e0189621. [DOI] [PubMed] [PMC]

Dadgostar P. Antimicrobial Resistance: Implications and Costs. Infect Drug Resist. 2019;12:3903–10. [DOI] [PubMed] [PMC]

Chaaban T, Ezzeddine Z, Ghssein G. Antibiotic misuse during the COVID-19 pandemic in Lebanon: a cross-sectional study. COVID. 2024;4:921–9. [DOI]

Daniel Markley J, Bernard S, Bearman G, Stevens MP. De-escalating Antibiotic Use in the Inpatient Setting: Strategies, Controversies, and Challenges. Curr Infect Dis Rep. 2017;19:17. [DOI] [PubMed]

10.

Trupka T, Fisher K, Micek ST, Juang P, Kollef MH. Enhanced antimicrobial de-escalation for pneumonia in mechanically ventilated patients: a cross-over study. Crit Care. 2017;21:180. [DOI] [PubMed] [PMC]

11.

Kollef MH. Broad-spectrum antimicrobials and the treatment of serious bacterial infections: getting it right up front. Clin Infect Dis. 2008;47 Suppl 1:S3–13. [DOI] [PubMed]

12.

Tabah A, Cotta MO, Garnacho-Montero J, Schouten J, Roberts JA, Lipman J, et al. A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit. Clin Infect Dis. 2016;62:1009–17. [DOI] [PubMed]

13.

Mancuso G, Midiri A, Gerace E, Biondo C. Bacterial Antibiotic Resistance: The Most Critical Pathogens. Pathogens. 2021;10:1310. [DOI] [PubMed] [PMC]

14.

Nadeem SF, Gohar UF, Tahir SF, Mukhtar H, Pornpukdeewattana S, Nukthamna P, et al. Antimicrobial resistance: more than 70 years of war between humans and bacteria. Crit Rev Microbiol. 2020;46:578–99. [DOI] [PubMed]

15.

Pitiriga V, Vrioni G, Saroglou G, Tsakris A. The Impact of Antibiotic Stewardship Programs in Combating Quinolone Resistance: A Systematic Review and Recommendations for More Efficient Interventions. Adv Ther. 2017;34:854–65. [DOI] [PubMed]

16.

Kherroubi L, Bacon J, Rahman KM. Navigating fluoroquinolone resistance in Gram-negative bacteria: a comprehensive evaluation. JAC Antimicrob Resist. 2024;6:dlae127. [DOI] [PubMed] [PMC]

17.

Lynch JP 3rd, File TM Jr, Zhanel GG. Levofloxacin for the treatment of community-acquired pneumonia. Expert Rev Anti Infect Ther. 2006;4:725–42. [DOI] [PubMed]

18.

Khan AS, Iqbal A, Muhammad AA, Mazhar F, Lodhi MF, Ahmed KF, et al. Safety and Efficacy of Nemonoxacin vs Levofloxacin in Patients With Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Randomized Control Trials. Cureus. 2023;15:e37650. [DOI] [PubMed] [PMC]

19.

Deshpande A, Richter SS, Haessler S, Lindenauer PK, Yu PC, Zilberberg MD, et al. De-escalation of Empiric Antibiotics Following Negative Cultures in Hospitalized Patients With Pneumonia: Rates and Outcomes. Clin Infect Dis. 2021;72:1314–22. [DOI] [PubMed] [PMC]

20.

Joung MK, Lee JA, Moon SY, Cheong HS, Joo EJ, Ha YE, et al. Impact of de-escalation therapy on clinical outcomes for intensive care unit-acquired pneumonia. Crit Care. 2011;15:R79. [DOI] [PubMed] [PMC]

21.

Arnold HM, Micek ST, Skrupky LP, Kollef MH. Antibiotic stewardship in the intensive care unit. Semin Respir Crit Care Med. 2011;32:215–27. [DOI] [PubMed]

22.

Giantsou E, Liratzopoulos N, Efraimidou E, Panopoulou M, Alepopoulou E, Kartali-Ktenidou S, et al. De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate. Intensive Care Med. 2007;33:1533–40. [DOI] [PubMed] [PMC]

23.

Knaak E, Cavalieri SJ, Elsasser GN, Preheim LC, Gonitzke A, Destache CJ. Does antibiotic de-escalation for nosocomial pneumonia impact intensive care unit length of stay? Infect Dis Clin Pract. 2013;21:172–6. [DOI]

24.

López-Cortés LE, Delgado-Valverde M, Moreno-Mellado E, Goikoetxea Aguirre J, Guio Carrión L, Blanco Vidal MJ, et al.; SIMPLIFY study group. Efficacy and safety of a structured de-escalation from antipseudomonal β-lactams in bloodstream infections due to Enterobacterales (SIMPLIFY): an open-label, multicentre, randomised trial. Lancet Infect Dis. 2024;24:375–85. [DOI] [PubMed]