SESSION TYPE: Pneumonia Treatment and Antibiotic Resistance
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Community-acquired pneumonia (CAP) is the most common lower respiratory tract infection and one of the leading causes of infection-related deaths among adults in the United States. While adjunctive corticosteroid therapy has proven efficacy in experimental animal models as well as certain human infections e.g. Pneumocystis jirovecii pneumonia and pneumococcal meningitis, human clinical data regarding its role in CAP are equivocal and sometimes conflicting.
METHODS: Following a systematic search thorugh several databases, we performed a systematic review and meta-analysis of original studies that evaluated the use of corticosteroids among adults admitted with CAP. Two investigators independently selected research studies using pre-determined criteria. We pooled relative risks (RR) and associated 95% confidence intervals (CI) from the included studies using a random effects model.
RESULTS: Nine studies, including seven randomized controlled trials (RCTs), were reviewed and comprised 1200 patients. The overall quality of evidence was moderate. Although adjunctive steroid therapy had no effect on hospital mortality and several other outcomes, it was associated with reduced duration of ventilatory support (4.5 days less in the steroid group [-8.6, -0.25]) as well as reduced length of hospital stay (1.2 days less in the steroid group [-2.0, -0.37]). A priori sub-group analyses - including RCTs vs. non-RCTs and intensive care unit (ICU)-based vs. non-ICU based studies - and sensitivity analysis - excluding studies published before 2000 - did not alter these findings.
CONCLUSIONS: Moderate-quality evidence suggests that steroid use is associated with reduced length of stay in the hospital. In addition, patients with severe CAP experience a reduction in the number of days spent on ventilatory support.
CLINICAL IMPLICATIONS: Inpatients with CAP requiring systemic corticosteroid therapy for other indications may be administered corticosteroids without detrimental effects on mortality or any of several other outcomes. Adjunctive corticosteroid therapy may have a beneficial role for inpatients with CAP, especially those who are sick enough to require ventilatory support on admission.
DISCLOSURE: The following authors have nothing to disclose: Majid Shafiq, Muhammad Mansoor, Adnan Khan, Muhammad Sohail, Mohammad Murad
Will be discussing the use of systemic corticosteroid therapy among inpatients with community-acquired pneumoniaMayo Clinic, Rochester, MN