Time to Treat Severe Community-Acquired Pneumonia with Steroids?

This editorial examines conflicting trial results on the efficacy of adjunct glucocorticoid therapy for severe community-acquired pneumonia (CAP). The 2019 ATS/IDSA guidelines advised limited use due to poor evidence, endorsing steroids only in septic shock. Two more recent trials—one U.S.-based using methylprednisolone and one French (CAPE COD) using hydrocortisone—showed divergent mortality outcomes. The French trial found a significant mortality benefit when steroids were initiated within 24 hours, particularly in patients with confirmed bacterial infection and elevated C-reactive protein. Differences in trial design, sex distribution, pathogen profiles, and timing may explain the variance. The authors suggest that early steroid use may be beneficial in select ICU patients with severe CAP, excluding septic shock and influenza cases.

This editorial examines conflicting trial results on the efficacy of adjunct glucocorticoid therapy for severe community-acquired pneumonia (CAP). The 2019 ATS/IDSA guidelines advised limited use due to poor evidence, endorsing steroids only in septic shock. Two more recent trials—one U.S.-based using methylprednisolone and one French (CAPE COD) using hydrocortisone—showed divergent mortality outcomes. The French trial found a significant mortality benefit when steroids were initiated within 24 hours, particularly in patients with confirmed bacterial infection and elevated C-reactive protein. Differences in trial design, sex distribution, pathogen profiles, and timing may explain the variance. The authors suggest that early steroid use may be beneficial in select ICU patients with severe CAP, excluding septic shock and influenza cases.