Deshpande A, Richter SS, Haessler S, et al. - For patients at risk for multidrug-resistant organisms, the IDSA/ATS guidelines advocate empiric therapy against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas and recommend antimicrobial de-escalation following negative cultures. Researchers here examined antibiotic de-escalation practices across hospitals. Further, they examined how these practices are associated with outcomes in hospitalized pneumonia patients with negative cultures. Assessment of 14,170 adults who were admitted with pneumonia in 2010-2015 to 164 US hospitals and had negative blood and/or respiratory cultures and had received both anti-MRSA and antipseudomonal agents other than quinolones. Initial empiric drugs were stopped by hospital day 4 in 1,924 (13%) patients. This indicates antibiotic de-escalation in a minority of eligible pneumonia patients by hospital day 4 following negative cultures; the hospitals varied widely in de-escalation rates. Substantial changes in practice will be required to adhere to recent guidelines.