Adjunct prednisone therapy for patients with community-acquired pneumonia: a randomized, placebo-controlled multicenter trial

Blum, CA; Nigro, N; Briel, Matthias; Schuetz, Philipp; Ullmer, Elke; Suter‐Widmer, Isabelle; Winzeler, Bettina; Bingisser, Roland; Elsaesser, Hanno; Drozdov, Daniel; Arici, Birsen; Urwyler, SA; Refardt, Julie; Tarr, Philip; Wirz, Sebastian; Thomann, Robert V.; Baumgärtner, C.; Duplain, Hervé; Burki, Dieter; Zimmerli, Werner; Rodondi, Nicolas; Müeller, Beat

doi:10.1186/cc14205

Cited by 3 publications

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“…3,22–24 It is worth noting that there is evidence regarding the dual behavior of immunosuppressive treatment, since although it may favor the appearance of infectious processes, in patients with established pneumonia it can limit the extent of the inflammatory response associated with sepsis, and improve the outcome. 23…”

Section: Discussionmentioning

confidence: 99%

“…20,21 There are no previous studies that have focused on factors associated with the development of complications in patients with SLE once they present with the episode of pneumonia; rather, researchers had focused on risk factors for developing pneumonia and had mainly identified use of immunosuppressants and/or corticosteroids, disease activity and even oral hygiene. 3,[22][23][24] It is worth noting that there is evidence regarding the dual behavior of immunosuppressive treatment, since although it may favor the appearance of infectious processes, in patients with established pneumonia it can limit the extent of the inflammatory response associated with sepsis, and improve the outcome. 23 Another objective of this study was to evaluate the behavior of two scales commonly used in patients with pneumonia to establish low risk of complications and to determine which patients can receive treatment on an outpatient basis.…”

Section: Discussionmentioning

confidence: 99%

“…3,[22][23][24] It is worth noting that there is evidence regarding the dual behavior of immunosuppressive treatment, since although it may favor the appearance of infectious processes, in patients with established pneumonia it can limit the extent of the inflammatory response associated with sepsis, and improve the outcome. 23 Another objective of this study was to evaluate the behavior of two scales commonly used in patients with pneumonia to establish low risk of complications and to determine which patients can receive treatment on an outpatient basis. We observed a high rate of complications in patients with low scores on these scales.…”

Section: Discussionmentioning

confidence: 99%

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Pneumonia in patients with systemic lupus erythematosus: Epidemiology, microbiology and outcomes

García-Guevara

Rios-Corzo

Díaz-Mora

et al. 2018

Lupus

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Background and objective Pneumonia remains the main cause of mortality in patients with systemic lupus erythematosus (SLE). The aim of the study was to establish the clinical characteristics, microbiology and risk factors for poor prognosis in patients with SLE and pneumonia. Methods We reviewed medical records of patients with SLE (American College of Rheumatology criteria) and pneumonia who attended the emergency room in a single tertiary care center (January 2010-March 2015). We collected demographics, treatment and disease activity (SLEDAI-2K) data. Severity scales of pneumonia (CURB-65 (acronym for risk factors measured: confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older) and Pneumonia Severity Index (PSI)) were obtained. A negative composite outcome was defined as need for mechanical ventilation, septic shock or death secondary to pneumonia up to 30 days after discharge. We conducted a univariate and multivariable analysis. Results We studied 158 patients (76% women) with 187 episodes of pneumonia. There were no differences in age, SLE duration, SLE activity, treatment or comorbidities between patients with negative composite outcome vs the other group. In 53 episodes, patients presented with a negative composite outcome. Of these, 46 (24.6%) required intubation, 13 (7%) developed shock and 12 (6.4%) died. The most common bacteria isolated was S. aureus, and we observed a high percentage of nonhabitual microorganisms. Fifteen percent of patients who presented with a negative outcome had low values on CURB-65 and PSI scales. Conclusion Patients with SLE and pneumonia have a high risk of complications and present with a high percentage of nonhabitual microorganisms. Severity scales for pneumonia can misclassify as low risk SLE patients with poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pneumonia in patients with systemic lupus erythematosus: Epidemiology, microbiology and outcomes

García-Guevara

Rios-Corzo

Díaz-Mora

et al. 2018

Lupus

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“…Recently, two multi-center double-blind randomized placebo-controlled trials have shown a benefit for steroids in the management of CAP [73,74]. The Lancet study randomized hospitalized CAP patients to prednisone 50 mg once daily or placebo for 1 week.…”

Section: Adjunctive Therapymentioning

confidence: 99%

Community-acquired pneumonia: An overview

Mandell

2015

Postgraduate Medicine

120

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Community-acquired pneumonia is still a significant cause of morbidity and mortality and is often misdiagnosed and inappropriately treated. Although it can be caused by a wide variety of micro-organisms, the pneumococcus, atypicals, such as Mycoplasma pneumoniae and Chlamydophila pneumoniae, Staphylococcus aureus and certain Gram-negative rods are the usual pathogens encountered. The site-of-care decision is critical in determining the site and type of care as well as the extent of diagnostic workup. Antimicrobial therapy should be started as soon as possible particularly in those requiring admission to hospital, but typically the physician does not know with any degree of certainty the identity of the etiologic pathogen. A number of national guidelines have been published to help the physician with this choice. The initial drug(s) can be modified if necessary if the pathogen and its antimicrobial susceptibility pattern becomes known. Adjunctive therapy such as pressors and fluid replacement are of value and macrolides appear to help as well, likely secondary to their immunomodulatory effects. Recent data also suggest a role for steroids.

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“…The second study from Switzerland randomized 785 patients to either prednisone 50 mg daily or placebo for 7 days. Prednisone shortened the time to clinical stability by about 1.5 days without an increase in complications but did not improve mortality [81]. In the past 2-3 years four systematic reviews and meta-analyses of the value of steroids in CAP have been published.…”

Section: Adjunctive Therapy For Severe Capmentioning

confidence: 99%

Issues in Community-Acquired Pneumonia

Fong

2020

Current Trends and Concerns in Infectious Diseases

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Adjunct prednisone therapy for patients with community-acquired pneumonia: a randomized, placebo-controlled multicenter trial

Cited by 3 publications

References 0 publications

Pneumonia in patients with systemic lupus erythematosus: Epidemiology, microbiology and outcomes

Pneumonia in patients with systemic lupus erythematosus: Epidemiology, microbiology and outcomes

Community-acquired pneumonia: An overview

Issues in Community-Acquired Pneumonia

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