SummaryAlthough more than half of ward patients received guideline-concordant antibiotics, a number received nonrecommended community-acquired pneumonia (CAP) antibiotics, informing stewardship strategies and highlighting the need to harmonize CAP and healthcare-associated pneumonia guidelines. Healthcare-associated pneumonia risk, recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were associated with nonrecommended CAP antibiotics.