Pneumonia最新文献

{"title":"Trends in all-cause pneumonia and influenza hospitalization incidence by coding position - a study of US healthcare claims, 2014-2023.","authors":"Kelsie Cassell, Salini Mohanty, Kelly D Johnson, Thomas Weiss, Nicole Cossrow","doi":"10.1186/s41479-026-00207-0","DOIUrl":"https://doi.org/10.1186/s41479-026-00207-0","url":null,"abstract":"<p><strong>Background: </strong>The hospitalization rate for pneumonia among adults has decreased in the U.S. since the early 2000's. The increasing prevalence of chronic conditions among adults, especially those associated with risk factors for pneumonia caused by Streptococcus pneumoniae, influenza and respiratory syncytial virus, may be contributing to a larger population susceptible to pneumonia. Existing estimates utilizing claims data may underestimate the true rates of disease due to how diagnostic coding fields are used to define outcomes.</p><p><strong>Methods: </strong>A retrospective descriptive study of adult (> 18 years) ACPI inpatient hospitalizations was conducted using US healthcare claims data from 2014 to 2023. Principal ACPI hospitalizations were defined as those with a principal field code for ACPI only. Expanded principal ACPI hospitalizations were those with a principal code for ACPI or a principal code for sepsis, meningitis, COPD, empyema, and acute respiratory failure in combination with a secondary code for ACPI. Prevalence of risk factors indicative for pneumococcal pneumonia, RSV, or severe influenza vaccination were assessed.</p><p><strong>Results: </strong>Principal ACPI showed the largest decline in incidence and this decline was greatest among the younger age groups compared to the older adults. In contrast, the expanded principal definition of ACPI captured between 48.5 and 63.4% of ACPI codes present in any field and showed lower variation over time compared to the principal definition. The proportion of adults with a risk factor of interest increased during the study period, particularly between 2020 and 2023. Greater than 96% of adults ≥ 65y hospitalized with ACPI in 2023 had at least one risk factor indicative for vaccination against pneumococcal, influenza, or RSV in the 3 years prior.</p><p><strong>Conclusions: </strong>We show that using only principal diagnostic codes to identify ACPI hospitalization may disproportionately inflate the decline in ACPI hospitalizations between 2014 and 2023. Using a principal ACPI hospitalization definition would exclude approximately 30% of hospitalizations that would meet the expanded principal ACPI definition. The shift towards greater use of sepsis and COPD codes in the principal diagnostic code position may be attributed to coding changes over the study period. Risk factors for pneumonia increased in prevalence, particularly during the COVID-19 pandemic period.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-acquired Haemophilus influenzae pneumonia in people living with HIV: a 30-year propensity score-matched cohort study.","authors":"Catia Cillóniz, Antonio Campanella, Riccardo Guglielmi, Daniela Malano-Barletta, Albert Gabarrús, Maria-Angeles Marcos, Antoni Torres, Jose M Miro","doi":"10.1186/s41479-026-00210-5","DOIUrl":"10.1186/s41479-026-00210-5","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the clinical characteristics, management, and outcomes of community-acquired pneumonia (CAP) caused by Haemophilus influenzae in people living with HIV (PWH) versus HIV-negative patients, and to evaluate whether HIV infection independently influences disease severity, intensive care unit (ICU) admission, or short- and long-term mortality.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of prospectively collected data including all consecutive adults hospitalized with CAP at a tertiary teaching hospital in Spain between 1996 and 2025. Microbiological confirmation of H. influenzae was obtained using standard diagnostic methods. Clinical variables, treatments, and outcomes were compared between PWH and HIV-negative patients. Propensity score matching (1:3) was applied to adjust for baseline differences. Multivariable generalized linear and Cox regression models were used to assess the association between HIV status and ICU admission, 30-day, 90-day, and 1-year mortality.</p><p><strong>Results: </strong>Among 202 patients, 18 (9%) were PWH. Before matching, PWH were younger, more frequently current smokers, and had higher rates of chronic liver disease. After propensity score matching, 18 PWH were compared with 54 HIV-negative controls. No significant differences were observed in disease severity, complications, ICU admission, or mortality. No deaths occurred among PWH during follow-up. HIV status was not independently associated with ICU admission or mortality at any time point. However, confidence intervals were wide and the number of events was limited, reducing statistical power and precision of estimates.</p><p><strong>Conclusions: </strong>In hospitalized patients with H. influenzae CAP, HIV infection was not associated with worse short- or long-term outcomes. However, given the small sample size and low number of outcome events, clinically meaningful differences cannot be excluded. Preventive strategies, including vaccination and optimized antiretroviral therapy, remain essential to reduce pneumonia burden in PWH.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare resource utilization and cost of invasive pneumococcal disease, pneumonia, and acute otitis media in commercially and medicaid-insured children by risk group in the United States, 2018 to 2023.","authors":"Salini Mohanty, Nicolae Done, Yan Song, Travis Wang, Abigail Zion, Emily Reichert, Tayler Li, Meghan White, Kelsie Cassell, Yi-Ling Huang, Kelly D Johnson, Natalie Banniettis, Jessica P Weaver, Kristen A Feemster","doi":"10.1186/s41479-026-00206-1","DOIUrl":"10.1186/s41479-026-00206-1","url":null,"abstract":"<p><strong>Background: </strong>Pneumococcal disease (PD) is a leading cause of morbidity among US children, particularly those with chronic medical conditions (CMC) and immunocompromising conditions (IC), and the decline in PD incidence was less pronounced in the late pneumococcal conjugate vaccine (PCV) 13 period. This study quantified healthcare resource utilization (HCRU) and costs among commercially and Medicaid-insured children with PD.</p><p><strong>Methods: </strong>This retrospective observational cohort study used Merative™ MarketScan® Commercial Database and Multi-State Medicaid Databases to identify children with invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and acute otitis media (AOM) episodes using inpatient and outpatient claims. HCRU and costs per PD episode were assessed in the commercially and Medicaid-insured populations, stratified by age (<2, 2-4, and 5-17 years) and risk group (CMC, IC, and no CMC/IC).</p><p><strong>Results: </strong>Between 2018 and 2023, commercially insured children contributed 23.6 million person-years (PY) and Medicaid-insured children contributed 23.4 million PY; 423 and 664 children had IPD, 309,540 and 281,569 had ACP, and 2,721,354 and 2,596,201 had AOM in the commercial and Medicaid populations, respectively. In both databases, HCRU and cost was higher in children with CMC or IC, compared to no CMC/IC across age groups for all PD manifestations. For IPD and ACP, inpatient admissions were 1.4 to 2.2-fold longer for children with CMC or IC. For IPD, costs per episode were 2-to-3-fold higher in children with CMC or IC, compared with those without CMC/IC (Commercial: $76,278 and $72,130 vs. $22,371; Medicaid: $17,389 and $19,945 vs. $6,476, respectively). For ACP, costs were highest in children with IC, followed by CMC and no CMC/IC (Commercial: $7,343, $2,637, and $809; Medicaid: $3,257, $1,160, and $356, respectively). AOM showed a similar pattern, with highest costs in children with IC (Commercial: $608; Medicaid: $178), followed by CMC ($442; $141), and lowest in those without CMC/IC ($368; $123).</p><p><strong>Conclusions: </strong>US children with underlying conditions that increase susceptibility to PD experience substantially higher HCRU and costs compared with those without such conditions, across all PD manifestations, regardless of insurance type and age group. These findings underscore the need for risk-based prevention strategies, including vaccination, beyond early childhood in high-risk pediatric populations.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A clinician's guide to corticosteroid therapy in pneumonia and critical illness: agent selection, dosing, monitoring, and interactions.","authors":"Niloofar Khoshnam Rad, Tayebeh Lakzaei, Maryam Nakhostin, Sara Soltanmohammadi","doi":"10.1186/s41479-026-00209-y","DOIUrl":"10.1186/s41479-026-00209-y","url":null,"abstract":"<p><p>Corticosteroids are cornerstone therapies in critically ill patients with severe pneumonia, acute respiratory distress syndrome (ARDS), and septic shock. However, their optimal application requires nuanced, syndrome-specific decision-making rather than a \"one-size-fits-all\" approach. This review provides a practical, evidence-based framework tailored specifically for adult patients in the ICU, defining a clear target audience of intensivists, pulmonologists, infectious disease specialists, and critical care pharmacists. We focus on six pillars: (1) the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI); (2) syndrome-specific agent selection supported by landmark trials; (3) precise dosing, administration, and tapering strategies; (4) structured safety monitoring; (5) management of high-risk drug-drug interactions; and (6) a comparative analysis of efficacy across agents. By synthesizing data from the CAPE COD, RECOVERY, DEXA-ARDS, APROCCHSS, and ADRENAL trials alongside the 2024 SCCM/ESICM focused guidelines, this guide offers a bedside roadmap for optimizing corticosteroid therapy in the ICU. Important distinctions are made between viral etiologies (benefit in COVID-19, systematic harm in influenza), and clinical exceptions are clearly defined. A dedicated section addresses the unique challenges of corticosteroid use in immunocompromised hosts, a population systematically excluded from landmark trials but increasingly encountered in ICU practice. Practical algorithms, monitoring tables, and drug interaction checklists are provided to support real-time clinical decision-making.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasopharyngeal microbiota profiles and lytA-PCR status in adult pneumococcal pneumonia: distinct microbial communities and diagnostic implications.","authors":"Beatriz Dietl, Desirée Henares, Miguel Blanco-Fuertes, Lucía Boix-Palop, Mireia Rajadell, Eva Cuchí, Amaresh Pérez-Argüello, Pedro Brotons, Aleix Lluansí, Carmen Muñoz-Almagro, Esther Calbo","doi":"10.1186/s41479-026-00205-2","DOIUrl":"10.1186/s41479-026-00205-2","url":null,"abstract":"<p><strong>Background: </strong>Streptococcus pneumoniae is a leading cause of community-acquired pneumonia (CAP) in adults, yet microbiological diagnosis remains challenging. Quantitative lytA-PCR on nasopharyngeal samples has improved diagnostic yield; however, a substantial proportion of patients with confirmed pneumococcal pneumonia (PPn) remain lytA-negative. We hypothesized that nasopharyngeal microbiota profiles differ according to lytA-PCR status on nasopharynx and may reflect distinct pathogenetic pathways.</p><p><strong>Methods: </strong>We conducted a prospective, observational study including adults hospitalized with confirmed PPn. Nasopharyngeal samples were collected before initiation of antimicrobial therapy for lytA-PCR quantification and 16S rRNA gene sequencing. Patients were stratified according to nasopharyngeal lytA-PCR status. Microbiota diversity and composition were analysed at the genus and amplicon sequence variant (ASV) levels. Differential abundance was assessed using ALDEx2, and associations between pneumococcal load and Streptococcus ASVs were explored.</p><p><strong>Results: </strong>Among 38 patients, 24 (63%) were lytA-positive and 14 (37%) lytA-negative in nasopharyngeal samples. Alpha-diversity did not differ between groups. However, beta-diversity analysis at the ASV level revealed significant compositional differences according to lytA status. Streptococcus spp. were significantly enriched in lytA-positive patients, whereas Corynebacterium and Dolosigranulum were more abundant in lytA-negative patients. Specific Streptococcus ASVs, consistent with S. pneumoniae, were enriched in lytA-positive samples and correlated with pneumococcal load.</p><p><strong>Conclusions: </strong>Among adults with pneumococcal pneumonia, nasopharyngeal lytA-PCR identified two distinct patterns of nasopharyngeal microbiota composition. These findings support the coexistence of colonization-driven and invasion-driven disease pathways and highlight the added value of integrating microbiota profiling with molecular diagnostics to better understand pneumococcal disease pathogenesis in adults.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumococcal pneumonia in adults - re-emergence of vaccine serotypes: a prospective multicenter cohort study in Germany, 2020-2023.","authors":"Christina Bahrs, Norman Rose, Grit Barten-Neiner, Carolin Fleischmann-Struzek, Mark P G van der Linden, Gernot Rohde, Jan Rupp, Martin Witzenrath, Jessica Rademacher, Mathias W Pletz","doi":"10.1186/s41479-026-00204-3","DOIUrl":"10.1186/s41479-026-00204-3","url":null,"abstract":"<p><p>The main burden of non-invasive pneumococcal diseases in adults is largely due to community-acquired pneumonia (CAP). This study aimed to investigate the distribution and dynamics of pneumococcal vaccine serotypes and to determine the proportion of CAP cases attributable to serotypes covered by 13-valent conjugate vaccine (PCV13), the 20-valent conjugate vaccine (PCV20), and the 23-valent polysaccharide vaccine (PPV23) among adults in Germany from 2020 to 2023. In this prospective multicenter cohort study, we analyzed all adult patients with CAP enrolled between January 1, 2020, and December 31, 2023, at 26 centers in Germany who provided urine samples for serotype-specific urine antigen detection (SSUAD) testing. Annual trends of pneumococcal vaccine serotypes from 2020 to 2023 were calculated for all patients and patient groups at risk using cluster-robust generalized linear models with heteroscedasticity-consistent standard errors. Of the 2,028 patients with all-cause CAP, 1,504 (1,008 patients aged ≥ 60 years, 373 younger patients with at least one comorbidity) had urine samples analyzed with SSUAD tests. Overall proportion of vaccine-type pneumococcal pneumonia among all-cause CAP for PCV13, PCV20, and PPV23 serotypes was 5.41% (95% CI 4.12-7.06%), 8.11% (95% CI 6.35-10.31%), and 8.31% (95% CI 6.27-10.93%), and serotype 3 was the most prevalent serotype (52 cases). Among patients aged ≥ 60 years, an increasing annual trend was observed for serotype 3 (OR 1.84, 95% CI 1.01-2.67), PCV13 (OR 1.89, 95% CI 0.89-2.89), PCV20 (OR 1.57, 95% CI 0.99-2.14), and PPV23 serotypes (OR 1.47, 1.04-1.91). The findings demonstrate that vaccine serotypes, particularly serotype 3, continued to circulate and reemerged among older adults with CAP in Germany.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of a Viremia-Integrated Risk Assessment (VIRA score) for predicting mortality at diagnosis of COVID-19 pneumonia.","authors":"Sonsoles Salto-Alejandre, Cristina Rodríguez-Urbistondo, Javier Martin-Escolano, Ana Ruiz-Molina, Carmen Infante-Domínguez, Gabriela Abelenda-Alonso, Mikel Del Álamo, Natalia Maldonado, Francisco Arnaiz-De Las Revillas, Jorge Alba, Alexander Rombauts, Regino J Rodríguez-Álvarez, Zaira R Palacios-Baena, Claudia González-Rico, Sonia Santibañez, Marta Carretero-Ledesma, Laura Merino, Belén Gutiérrez-Gutiérrez, Mónica Gozalo-Margüello, María Carmen Fariñas, José Antonio Oteo, Ane J Goikoetxea-Agirre, Jordi Carratalá, Jesús Rodríguez-Baño, Elisa Cordero, Rocío Álvarez-Marín, Manuela Aguilar-Guisado, José Miguel Cisneros, Jerónimo Pachón, Javier Sánchez-Céspedes","doi":"10.1186/s41479-026-00208-z","DOIUrl":"10.1186/s41479-026-00208-z","url":null,"abstract":"<p><strong>Background: </strong>CURB-65 score usefulness has been assessed in COVID-19 pneumonia, but not in cohorts including immunocompromised patients. SARS-CoV-2 RNAemia is associated with mortality and unfavorable clinical outcomes in COVID-19. This study aimed to develop the VIRA score (Viremia-Integrated Risk Assessment), incorporating CURB-65 and RNAemia, for predicting 30-day COVID-19 pneumonia mortality.</p><p><strong>Methods: </strong>We included two multicenter cohorts of COVID-19 pneumonia: 539 immunocompetent and 280 immunocompromised patients, vaccinated against SARS-CoV-2 in 191 (35.4%) and 240 (85.7%), respectively. We employed multivariable logistic regression to identify predictors of 30-day mortality, with model performance assessed through area under the receiver operating characteristic curve (AUROC), and internal validation using calibration plots and bootstrap resampling. CURB-65 was available in 422 immunocompetent and 222 immunocompromised patients, constituting the derivation cohorts for the VIRA score. Integrated discrimination improvement was calculated for the addition of RNAemia, dyspnea, and male sex to CURB-65. Logistic regression coefficients were converted to the VIRA score for clinical application.</p><p><strong>Results: </strong>Mortality rates were 5.2% in immunocompetent and 15.0% in immunocompromised patients. Although CURB-65 ≥ 2 was associated with 30-day mortality in both groups (p < 0.001 and p = 0.001), the score consistently underestimated observed mortality across risk categories, most markedly in immunocompromised patients, where predicted mortality for the high-risk category (3 points: 14.5%) contrasted sharply with the observed 50.0%. At the high-risk threshold (CURB-65 score ≥ 3), sensitivity was poor in both groups (9.1% in immunocompetent and 8.6% in immunocompromised patients), with NPV of 95.2% and 85.3%, respectively. Incorporating RNAemia improved CURB-65's discriminatory performance, raising AUROCs in immunocompetent (0.806 [95% CI, 0.701-0.910] vs. 0.771 [95% CI, 0.661-0.881]; IDI 0.023) and immunocompromised (0.745 [95% CI, 0.639-0.851] vs. 0.637 [95% CI, 0.532-0.742]; IDI 0.121) cohorts. At the equivalent high-risk cut-off (score ≥ 2), the VIRA score substantially improved sensitivity and NPV over CURB-65 alone: from 9.1% to 72.7% and from 95.2% to 98.2% in immunocompetent patients, and from 8.6% to 60.0% and from 85.3% to 91.9% in immunocompromised patients.</p><p><strong>Conclusions: </strong>RNAemia strengthens CURB-65's predictive accuracy for 30-day mortality of SARS-CoV-2 pneumonia. The VIRA score, freely accessible at virascore.com, improves risk stratification especially in higher-risk categories and in immunocompromised patients.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic non-susceptibility associated serotypes of invasive pneumococcal disease - a nationwide population study from Switzerland, 2012-2022.","authors":"Nicolaj Just, Carlo Casanova, Florent Baty, Werner C Albrich, Markus Hilty","doi":"10.1186/s41479-026-00203-4","DOIUrl":"10.1186/s41479-026-00203-4","url":null,"abstract":"<p><strong>Introduction: </strong>It has been reported that the introduction of thirteen-valent pneumococcal conjugate vaccine (PCV13) had an influence on antibiotic resistance rates of invasive pneumococcal disease (IPD). Recent data about antibiotic resistance in IPD are scarce. The aim of the current study was to analyse the impact of PCV13 introduction and COVID-19 pandemic on antibiotic resistance in IPD and the effects of antibiotic resistance on mortality. Furthermore, we correlate vaccine and non-vaccine serotypes with antibiotic resistance.</p><p><strong>Methods: </strong>We included 8747 IPD cases from a Swiss nationwide IPD surveillance database for 2012-2022. Regression analyses were performed to examine significant trends over time and to identify serotypes and patient characteristics associated with antibiotic resistance.</p><p><strong>Results: </strong>The proportion of non-susceptibility to erythromycin (IRR: 0.9, p < 0.001) and cotrimoxazole (IRR: 0.9, p < 0.001) decreased from 2012 to 2022. Penicillin non-susceptibility remained constant with a dip in 2022 (2012: 9.2%, 2022: 4.7%). PCV13 serotypes 6B, 9V, 14, 19A and 19F were significantly associated with non-susceptibility while the non-PCV13 serotype 15A, 23B, 24/F and 6C were associated with resistance to at least two antibiotic groups. Antibiotic non-susceptibility was not associated with death but meningitis was associated with penicillin non-susceptibility.</p><p><strong>Conclusions: </strong>Antibiotic resistance in IPD decreased over time without increases during the COVID-19 pandemic, while a strong association between serotypes and antibiotic resistance persists. Introduction of vaccines with extended serotype coverage may further affect antibiotic resistance rates underlining the importance of continued surveillance.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroids in immunocompromised ICU patients with pneumonia: risks, evidence, and clinical practice.","authors":"Jeison Andrés Morales-Olivera, Paula O Narvaez-Ramirez, Ingrid G Bustos, Lina F Martinez-Lemus, Natalia Sanabria-Herrera, Cristian C Serrano-Mayorga, Valeria Aguirre Gutierrez, Alex Julián Forero-Delgadillo, Lina Mar Mendez-Castillo, Gina Sofia Montaño, Luis Felipe Reyes","doi":"10.1186/s41479-026-00202-5","DOIUrl":"10.1186/s41479-026-00202-5","url":null,"abstract":"<p><p>Adjunctive corticosteroids are increasingly used in Severe Community-Acquired Pneumonia (sCAP) requiring admission to the intensive care unit (ICU), based on evidence derived largely from immunocompetent populations. Immunocompromised hosts, however, represent a distinct and growing subgroup among critically ill patients with sCAP, characterised by baseline immune defects, broader pathogen spectra, and a heightened susceptibility to treatment-related harm. Whether corticosteroid strategies validated in the general population can be safely and effectively extrapolated to immunocompromised ICU patients with sCAP remains uncertain, despite their growing use in contemporary ICU practice. Immunocompromised patients admitted to the ICU with sCAP experience compounded alterations in host defence, driven by pre-existing immune dysfunction and superimposed critical illness-associated immune dysregulation. In this setting, corticosteroids may attenuate inflammation-mediated lung injury, but may also deepen immune suppression, distort clinical evolution, and increase susceptibility to opportunistic superinfections and pathogen reactivation. Randomised trials and meta-analyses supporting corticosteroid use in sCAP have systematically excluded immunocompromised patients, treating immunosuppression as an exclusion criterion rather than a stratification variable, and commonly rely on short-term endpoints that fail to capture delayed infectious complications relevant to this population. Available observational data and pathogen-specific evidence suggest substantial heterogeneity of treatment effect (HTE) across immunocompromised subgroups, influenced by immune substrate, pathogen context, and cumulative immunosuppressive burden. Among the pathogen-specific contexts in which corticosteroids have the strongest evidence, Pneumocystis jirovecii pneumonia (PJP) stands out as the principal indication: adjunctive corticosteroids have demonstrated clear mortality benefit in AIDS-associated severe PJP, though this benefit does not extend uniformly to HIV-negative immunocompromised patients with PJP. Consequently, standard corticosteroid treatment in all CAP subgroups is unlikely to be appropriate. In immunocompromised ICU patients with sCAP, corticosteroid therapy should neither be routinely applied nor categorically avoided. Instead, decisions should be individualised, guided by a clearly defined therapeutic target, careful assessment of immune status, and consideration of the risk for opportunistic infections. When used, corticosteroids should be administered at the lowest effective dose and for the shortest feasible duration. Dedicated studies incorporating immune stratification, pathogen-informed approaches, and outcomes relevant to delayed infections are urgently needed. Until such evidence is available, careful risk-balance assessments to decide steroids in these patients.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13295518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicentre case-control study about effectiveness of pneumococcal vaccination against pneumonia hospitalization in at-risk adults.","authors":"María Liébana, Diana Toledo, Núria Soldevila, María Morales-Suarez-Varela, Concepción Prados-Sánchez, Amelia Fernandez-Sierra, Gemma Navarro, Vicente Martín, Judith Chamorro, Mikel Egurrola, Marta Rodriguez-Suárez, Angela Domínguez","doi":"10.1186/s41479-026-00201-6","DOIUrl":"10.1186/s41479-026-00201-6","url":null,"abstract":"<p><p>BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity in adults with chronic conditions. Although pneumococcal vaccine effectiveness (VE) has been demonstrated in older adults, evidence is scant regarding adults < 65 years. We evaluated pneumococcal VE against CAP-related hospitalization in at-risk adults aged 18–64 years. METHODS: We conducted a multicentre case-control study in Spain (2020–2024). Cases were adults aged 18–64 years with risk conditions, hospitalized for ≥ 24 h, with radiological and clinical patterns compatible with CAP. Controls were hospitalized patients with risk conditions but without pneumonia. Vaccination status was classified as 23-valent pneumococcal polysaccharide vaccine only, pneumococcal conjugate vaccine only, sequential vaccination, or unvaccinated. Logistic regression was used to estimate crude and adjusted odds ratio (OR) values, with VE calculated as (1–OR) × 100. Analyses were stratified by immune status, and a sensitivity analysis was performed excluding SARS-CoV-2 cases. RESULTS: We included 805 cases and 806 controls. None of the pneumococcal vaccination strategies showed significant effectiveness against hospitalization for CAP. In immunocompromised individuals, 23-valent pneumococcal polysaccharide vaccine showed significantly negative adjusted VE (-142.0, 95%CI: -504.4 to -1.1). Excluding SARS-CoV-2 cases yielded similar estimates. CONCLUSIONS: Pneumococcal vaccination was not associated with a reduced hospitalization risk for CAP in adults aged 18–64 years with risk conditions. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}