Empirical antibiotic therapy for spontaneous intracerebral hemorrhage-associated pneumonia: an ICU-based single-centered retrospective cohort study.

backgroundPneumonia is a common and severe complication following spontaneous intracerebral hemorrhage (SICH) and is associated with significantly worse clinical outcomes. However, there remains insufficient evidence supporting empirical antibiotic regimens for SICH-associated pneumonia (SICHAP).

objectiveTo evaluate the clinical efficacy of different empirical antibiotic regimens in patients with SICHAP and to provide evidence for optimizing initial antimicrobial strategies.

methodsThis single-center retrospective cohort study enrolled adult patients with SICH who developed pneumonia within 7 days of onset between July and December 2024. Patients were stratified according to their initial empirical antibiotic regimen: cefazolin (CFZ), ceftriaxone (CRO), cefoperazone-sulbactam (CFP-SUL), or piperacillin-tazobactam (PIP-TAZ). The primary outcome was the clinical efficacy rate at 72 h. The secondary outcomes included the SICHAP treatment failure rate, in-hospital mortality, length of stay, duration of mechanical ventilation, and duration of antibiotic therapy. Treatment appropriateness was assessed on the basis of sputum culture and antimicrobial susceptibility testing.

resultsA total of 85 patients (mean age 54.2 ± 13.5 years, 63.5% male) were enrolled, with 90.6% presenting with early SICHAP. The 72-hour efficacy rate in the CFP-SUL group (73.3%) was significantly greater than that in the CFZ group (25.0%), CRO group (54.5%), and PIP-TAZ group (58.8%) (p = 0.022). The overall SICHAP treatment failure rate was 55.3%, with no significant intergroup differences (p = 0.137). In the sputum culture-positive subgroup (n = 49), appropriate empirical antibiotic therapy (AEAT) significantly reduced treatment failure (58.1% vs. 94.4%, p = 0.008). Pathogens were predominantly Gram-negative (75.3%), with the most common isolates being Klebsiella pneumoniae (42.9%), Pseudomonas aeruginosa (40.8%), and Acinetobacter baumannii (22.4%). High rates of ESBL production and carbapenemase detection were observed.

conclusionAmong SICHAP patients, empirical CFP-SUL therapy demonstrated greater 72-hour clinical efficacy, and AEATs significantly reduced the risk of treatment failure. These findings suggest that CFP-SUL may be favored for early empirical antimicrobial therapy in this population, although prospective randomized controlled trials are needed to confirm these results. CLINICAL TRIAL: Clinical trial number: not applicable.