Effect of corticosteroids in critical patients with severe community-acquired pneumonia: emulation of a clinical trial

Abstract

Community-acquired pneumonia (CAP) continues to be one of the leading causes of mortality worldwide, and it is the leading cause of death from infectious diseases (1). Annually, approximately 4,000 new cases of this condition are reported, of which between 20% and 42% of patients require in hospital managment and treatment. In addition, patients with severe CAP (SCAP)a are a highlighted group due to their higher mortality risk. They represent between 10% and 30% of the total population with CAP and usually require admission to the intensive care unit (ICU)(2). Therefore, it is critical to provide an adequate and timely treatment to these patients in order to reduce mortality rates. According to Ceccato et al. (3), conventional antibiotic therapy has some limitations, because these drugs do not directly modulate the inflammatory response. Furthermore, it is known that between 10% - 15% of hospitalized patients with CAP may not respond to antibiotic therapy due to factors such as the etiological microorganism, the severity of CAP and characteristics of the host (4); hence, the use of corticosteroids has been studied as a biologically plausible treatment option due to its mechanism of action.