Pneumonia最新文献

{"title":"Corticosteroids in non-viral acute respiratory distress syndrome (ARDS): recommendations outpace evidence - a concise review.","authors":"Thanh Luan Nguyen, Phuc Tuong Pham, Van Phieu Duong, Hoang Ngoc Thao Duong","doi":"10.1186/s41479-025-00183-x","DOIUrl":"10.1186/s41479-025-00183-x","url":null,"abstract":"<p><p>The 2024 global redefinition of acute respiratory distress syndrome (ARDS) broadens diagnostic criteria to include patients on non-invasive respiratory support. While this inclusivity enhances early recognition, it also introduces heterogeneity in disease severity, inflammatory burden, and treatment responsiveness-complicating the use of corticosteroids. Although recent guidelines recommend corticosteroids for moderate-to-severe ARDS, they fall short of specifying optimal timing, dosing, and patient selection. The DEXA-ARDS trial showed that high-dose dexamethasone reduced mortality in moderate-to-severe ARDS regardless of etiology, but its generalizability to less severe or non-intubated patients remains unclear. Conversely, in severe community-acquired pneumonia (CAP), hydrocortisone regimens used in CAPE-COD and APROCCHSS trials demonstrated mortality benefits, suggesting a particular therapeutic niche for corticosteroids in non-viral, infection-associated ARDS. A recent network meta-analysis suggests that low-dose methylprednisolone may reduce ARDS mortality, though phenotype-specific efficacy is not well defined. Despite these encouraging signals, key questions persist: Which corticosteroid? At what dose? For which ARDS phenotype? As evidence accumulates unevenly across ARDS subtypes, guideline-endorsed recommendations may inadvertently mask the nuances required for individualized therapy. Until precision approaches are better defined, clinicians must balance empirical benefit with thoughtful restraint in applying corticosteroids to non-viral ARDS. This concise review summarizes current evidence, key limitations, and pragmatic phenotype-informed strategies for corticosteroid use in non-viral ARDS.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"28"},"PeriodicalIF":6.2,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228629","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":"Identification of age-group reservoirs for persistent vaccine-type pneumococcal carriage in rural Gambia.","authors":"Isaac Osei, Emmanuel Mendy, Kevin van Zandvoort, Olimatou Jobe, Golam Sarwar, Nuredin I Mohammed, Jane Bruce, Ousman Barjo, Minteh Molfa, Rasheed Salaudeen, Brian Greenwood, Stefan Flasche, Grant A Mackenzie","doi":"10.1186/s41479-025-00176-w","DOIUrl":"10.1186/s41479-025-00176-w","url":null,"abstract":"<p><strong>Background: </strong>Although pneumococcal conjugate vaccines (PCVs) have been used widely in many low and middle-income countries, residual vaccine-type (VT) carriage persists in these settings. We examined the role of specific age groups in transmission and as reservoirs of VT pneumococcal infection in The Gambia.</p><p><strong>Methods: </strong>Between January and November 2022, we conducted a nested, population-based, cross-sectional social contact and pneumococcal carriage survey in the Central and Upper River Regions of The Gambia. Participants completed questionnaires on carriage risk factors and social contacts. Nasopharyngeal swabs were collected from selected household members across all age groups. Streptococcus pneumoniae was isolated and serotyped using standard methods. We analysed matched contact and pneumococcal carriage data and estimated the proportions of VT carriage attributable to contact with different age groups.</p><p><strong>Results: </strong>A total of 1638 participants were enrolled, of which 67% were children aged 0-14 years. Pneumococcal carriage prevalence was 59.6% (95% CI: 53.9 - 65.1%) in 0-4 year-olds and 36.1% (95% CI: 29.6 - 43.1%) in 5-14 year-olds. PCV13 VT carriage prevalence was not significantly different (10-13%) between these age groups. Among pneumococcal carriers, the proportion of VT carriage was significantly higher in 5- 14-year-olds [35.7% (95% CI: 25.9 - 46.9%)] compared to 0-4-year-olds [17.8% (95% CI: 13.9 - 22.6%, p-value < 0.001)]. The odds of VT carriage were 10% higher [AOR = 1.10, 95% CI: 1.01-1.20] for each additional physical contact with a child aged 10-14 years. We estimated that children aged 5-14 years contributed about 63% to the overall risk of exposure to VT pneumococci in the population.</p><p><strong>Conclusions: </strong>In rural Gambia, school-aged children, particularly those aged 5-9 years, are the main drivers of VT pneumococcal transmission. In the context of high coverage of routine PCV vaccination in infants, this suggests waning PCV protection by school entry. A booster dose for children at school entry may support better control of VT circulation in the population.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"22"},"PeriodicalIF":6.2,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228566","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":"Assessing the prevalence and the underdiagnosis of aspiration pneumonia among older hospitalized patients with community-acquired pneumonia using an artificial intelligence algorithm.","authors":"Alberto Martín-Martínez, Clàudia Sitges-Milà, Jaume Miró, Cristina Amadó, Ramon Boixeda, Yuki Yoshimatsu, Dorte Melgaard, Pere Clavé, Omar Ortega","doi":"10.1186/s41479-025-00175-x","DOIUrl":"10.1186/s41479-025-00175-x","url":null,"abstract":"<p><strong>Introduction: </strong>Aspiration pneumonia (AP) in older persons is associated with oropharyngeal dysphagia (OD) and is estimated to account for 5-15% of cases of community-acquired pneumonia (CAP). Artificial Intelligence Massive Screening for OD (AIMS-OD) is an algorithm for identifying OD in older patients on hospital admission using data from electronic health records (EHR). We aimed to assess the prevalence of OD among older patients hospitalized with pneumonia and thus estimate the underdiagnosis of AP based on AIMS-OD.</p><p><strong>Materials and methods: </strong>A retrospective observational study included 15,603 patients older than 65 years who were admitted for pneumonia to a general hospital between 2013 and 2022. Clinical data were obtained from EHR. AIMS-OD is an accurate diagnostic algorithm (AUCROC > 0.79, specificity 0.92, PPV 0.86, NPV 0.58) for OD using AI and machine learning.</p><p><strong>Results: </strong>a) AP prevalence following traditional clinical practice (ICD-10 J69.0, AP codification) on discharge was 15.57% (n=2,430, 86.73±7.43 years); b) Estimated AP prevalence related to OD identified with AIMS-OD, was 25.32% (n=3,951, 85.11±8.78 years); c) AIMS-OD identified 84.77% (n=2,060, 87.17±7.09 years) of clinically diagnosed patients (ICD-10 J69.0), and 1,891 additional cases of AP (82.87±9.84 years) undetected by clinical practice, distinguishing them from pneumonia patients without OD in seconds.  CONCLUSION: The prevalence of AP following traditional clinical practice among older patients hospitalized with pneumonia was 15.57%. AIMS-OD revealed a potential prevalence of AP of 25.32%. AIMS-OD allows to increase by 62.6% the detection of AP related to OD versus traditional clinical practice among older patients hospitalized with pneumonia. AIMS-OD allows massive, immediate, and accurate identification of OD on hospital admission, from which AP cases can be identified, enabling early and specific treatment to improve the poor clinical outcomes of these unrecognized patients with AP and prevent its recurrence.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"23"},"PeriodicalIF":6.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138814","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":"Correction to: Pneumococci remain the main cause of complicated pediatric pneumonia in the post-pandemic era despite extensive pneumococcal vaccine use.","authors":"Joana Gomes-Silva, Marcos D Pinho, Ana Friaes, Mario Ramirez, Jose Melo-Cristino, Catarina Silva-Costa","doi":"10.1186/s41479-025-00179-7","DOIUrl":"10.1186/s41479-025-00179-7","url":null,"abstract":"","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"25"},"PeriodicalIF":6.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070391","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":"Clinical features and prognosis of severe legionnaires' disease requiring intensive care unit admission: a multicentric retrospective cohort study.","authors":"Anaïs Dartevel, Louis-Marie Galerneau, Vincent Peigne, Nicholas Sedillot, Stephan Ehrmann, Alexandre Lautrette, Kada Klouche, Julien Poissy, Guillaume Thiery, Bertrand Sauneuf, Jean-Philippe Rigaud, Michel Ramakers, Cédric Daubin, Carole Schwebel, Nicolas Terzi","doi":"10.1186/s41479-025-00173-z","DOIUrl":"10.1186/s41479-025-00173-z","url":null,"abstract":"<p><strong>Introduction: </strong>Legionella is the second cause of community-acquired pneumonia in Intensive Care Unit (ICU) patients. The aim of this study was to describe the epidemiology and outcome in patients with Legionella pneumonia (LP) in French ICUs.</p><p><strong>Methods: </strong>A multi-center, retrospective, observational study in 12 French ICUs was performed between January 2014 and December 2019.</p><p><strong>Results: </strong>LP was diagnosed in 162 patients during the study period. Invasive mechanical ventilation was required in 95 patients (58%), 73 (45%) of whom had acute respiratory distress syndrome (ARDS). Most of these patients were treated with a combination of antibiotics (128, patients; 79%). The most common combination consisted in a fluoroquinolone and a macrolide (118 patients). Median length of stay in an ICU was 11 [5; 11] days. At 28 days, 19 (12%) out of the 162 patients had not survived. In multivariate analyses, age (Incidence risk Ratio: IRR, 1.07; 95% CI, 1.01; 1.14) and a high Sequential Organ Failure Assessment (SOFA) score in the first 48 h (IRR, 1.47; 95% CI, 1.09; 2) were significantly associated with mortality.</p><p><strong>Conclusion: </strong>In this French multicentric cohort, the LP prognosis in ICUs was apparently more favorable than in the literature, possibly because of the timely and improved LP management in ICUs.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"21"},"PeriodicalIF":6.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973381","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":"Microbial profiling of community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease: a comprehensive molecular diagnostics study.","authors":"Dagfinn Lunde Markussen, Christoffer Lindemann, Sondre Serigstad, Synne Jenum, Christian Ritz, Harleen M S Grewal","doi":"10.1186/s41479-025-00172-0","DOIUrl":"10.1186/s41479-025-00172-0","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) causes substantial morbidity and mortality, particularly in patients with chronic obstructive pulmonary disease (COPD). This study compares the microbial detections in CAP patients with and without COPD using culture based and molecular diagnostic methods.</p><p><strong>Methods: </strong>This prospective study included 412 hospitalized pneumonia patients (136 with COPD). Lower respiratory tract samples were analysed with traditional cultures and a multiplex PCR panel (FilmArray Pneumonia Panel Plus). Multivariable Poisson regression identified predictors of Pseudomonas aeruginosa detection, and logistic regression estimated detection probability using the top predictors.</p><p><strong>Results: </strong>Overall pathogen detection rates were similar between groups, but P. aeruginosa was significantly more common in COPD patients (12.5% vs. 3.1%; p < 0.001). In adjusted analyses, each additional year of age increased the risk of P. aeruginosa by 5% (RR 1.05; 95% CI 1.01-1.09), while advanced COPD (GOLD 3-4) conferred a four-fold higher risk (RR 4.29; 95% CI 1.94-9.46), diabetes mellitus a four-fold risk (RR 4.04; 95% CI 1.97-8.29), and prior P. aeruginosa detection a five-fold risk (RR 5.03; 95% CI 2.44-10.36). Inhaler use, bronchiectasis, and recent hospitalization were not independently associated.</p><p><strong>Conclusion: </strong>Although overall microbial detection rates were comparable between groups, P. aeruginosa was disproportionately prevalent in high-risk COPD individuals. While most COPD patients with pneumonia can be managed with standard empirical antibiotics, empirical coverage for P. aeruginosa should be considered for selected high-risk patients. Prospective studies are warranted to evaluate targeted P. aeruginosa coverage to optimize antibiotic stewardship and improve outcomes.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"19"},"PeriodicalIF":6.2,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785595","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":"Test and treat-impact of microbiological testing on antibiotic prescribing for Legionnaires' disease in Switzerland: results of the multicentre SwissLEGIO study.","authors":"Melina Bigler, Florian Zacher, Sarah Dräger, Werner C Albrich, Daniel Mäusezahl","doi":"10.1186/s41479-025-00171-1","DOIUrl":"10.1186/s41479-025-00171-1","url":null,"abstract":"<p><strong>Background: </strong>Legionnaires' disease (LD) is a severe form of primarily community-acquired pneumonia (CAP). To confirm a Legionella infection, microbiological testing is required. The Swiss and European guidelines recommend LD testing for all hospitalised CAP patients. However, the low positivity rate of such routine testing (1.5-3%) raises concerns about its cost-effectiveness and clinical utility. In a setting where routine testing is recommended, this multicentre study evaluated the impact of LD testing on the clinical management of the infection and antimicrobial prescribing.</p><p><strong>Methods: </strong>Data from medical records of 195 community-acquired LD (CALD) patients from 20 Swiss hospitals (August 2022-March 2024) were analysed. We assessed the clinical management of CALD, focusing on the impact of microbiological testing on antibiotic prescribing. The appropriateness of antibiotic choice and duration of treatment was assessed using a standardised pathway analysis approach. Factors associated with unsupported antibiotic prescribing were assessed using mixed-effects logistic regression analysis.</p><p><strong>Results: </strong>Microbiological testing was initiated promptly, with results available within 24 h after presenting to the hospital for 85.1% and within 48 h for 92.3% of patients. Antibiotics with Legionella coverage were initiated in 88.2% of patients within 24 h of admission. A positive Legionella test influenced antibiotic prescribing: 97.9% of patients received antibiotics active against Legionella spp., and 79.6% were prescribed appropriate and targeted monotherapy within 24 h of receiving the test result. Overall, 35.4% of patients were treated with antibiotics for a median of 4 days (IQR 3-4 days) longer than guidelines recommend (defined as > 10 days for immunocompetent or > 21 days for immunocompromised patients). Prolonged treatment was associated with CALD severity and antibiotic use > 2 days postdischarge (proxy for clinical stability reached). 38.5% of patients with impaired renal function received a suboptimal loading dose of levofloxacin.</p><p><strong>Conclusion: </strong>Routine aetiological testing for LD has improved the clinical management of CALD by facilitating rapid detection of CALD cases and timely initiation of appropriate and targeted antibiotic therapy. Future antimicrobial stewardship efforts should sensitise physicians that a shorter duration of antibiotic treatment for CALD of 5 to 7 days according to the latest Swiss CAP guidelines is sufficient and safe.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"17"},"PeriodicalIF":6.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12291349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709419","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":"RSV: an overview of infection in adults.","authors":"Charles Feldman, Ronald Anderson","doi":"10.1186/s41479-025-00165-z","DOIUrl":"10.1186/s41479-025-00165-z","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) infection was originally considered to be simply a disease of childhood. However, it has increasingly been recognized that the virus may also cause infection in adults. Furthermore, great strides have been made in understanding the clinical manifestations, as well as aspects of its management and prevention, requiring the need for greater awareness of the various aspects of this infection in adults.</p><p><strong>Main body: </strong>There are several potential reasons that RSV may have been overlooked in adults. Firstly, it was due to a lack of knowledge that this infection could occur in this age group. Secondly, there was infrequent testing for RSV infection in adults, both for this reason and because RSV antigen testing in adults is less sensitive than in children. Thirdly, RSV diagnosis, therefore, required the performance of polymerase chain reaction (PCR) testing, which is both expensive and underutilized. Finally, there was also the belief at that time that if the infection was due to RSV, there was little one could do to about it in terms of treatment and/or prevention. More recently, however, enormous advances have been made particularly in the management and prevention of this infection. This manuscript, which is an extensive literature review, describes the modern understanding of the burden of infection, the clinical presentation, risk factors, immunopathogenesis, management, and prevention of RSV infections in adults.</p><p><strong>Conclusion: </strong>RSV virus is a common cause of respiratory tract infections in adults and advances in recent research have not only enhanced our knowledge of this infection but have led to the development of effective treatment and prevention of the infection.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"15"},"PeriodicalIF":8.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486545","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":"Are presentations of thoracic CT performed on admission to the ICU associated with mortality at day-90 in COVID-19 related ARDS?","authors":"Alexia Le Corre, Adel Maamar, Mathieu Lederlin, Nicolas Terzi, Jean-Marc Tadié, Arnaud Gacouin","doi":"10.1186/s41479-025-00166-y","DOIUrl":"10.1186/s41479-025-00166-y","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT) analysis of lung morphology has significantly advanced our understanding of acute respiratory distress syndrome (ARDS). During the Coronavirus Disease 2019 (COVID-19) pandemic, CT imaging was widely utilized to evaluate lung injury and was suggested as a tool for predicting patient outcomes. However, data specifically focused on patients with ARDS admitted to intensive care units (ICUs) remain limited.</p><p><strong>Methods: </strong>This retrospective study analyzed patients admitted to ICUs between March 2020 and November 2022 with moderate to severe COVID-19 ARDS. All CT scans performed within 48 h of ICU admission were independently reviewed by three experts. Lung injury severity was quantified using the CT Severity Score (CT-SS; range 0-25). Patients were categorized as having severe disease (CT-SS ≥ 18) or non-severe disease (CT-SS < 18). The primary outcome was all-cause mortality at 90 days. Secondary outcomes included ICU mortality and medical complications during the ICU stay. Additionally, we evaluated a computer-assisted CT-score assessment using artificial intelligence software (CT Pneumonia Analysis^®, SIEMENS Healthcare) to explore the feasibility of automated measurement and routine implementation.</p><p><strong>Results: </strong>A total of 215 patients with moderate to severe COVID-19 ARDS were included. The median CT-SS at admission was 18/25 [interquartile range, 15-21]. Among them, 120 patients (56%) had a severe CT-SS (≥ 18), while 95 patients (44%) had a non-severe CT-SS (< 18). The 90-day mortality rates were 20.8% for the severe group and 15.8% for the non-severe group (p = 0.35). No significant association was observed between CT-SS severity and patient outcomes.</p><p><strong>Conclusion: </strong>In patients with moderate to severe COVID-19 ARDS, systematic CT assessment of lung parenchymal injury was not a reliable predictor of 90-day mortality or ICU-related complications.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"14"},"PeriodicalIF":8.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227137","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":"Clinical effectiveness of oral antiviral treatment for non-hospitalized high-risk patients with COVID-19 during Omicron JN.1 subvariant wave: a US-based propensity-matched cohort study.","authors":"Wan-Hsuan Hsu, Bo-Wen Shiau, Po-Yu Huang, Ya-Wen Tsai, Jheng-Yan Wu, Ting-Hui Liu, Min-Hsiang Chuang, Shu-Farn Tey, Lun-Wu Hung, Chih-Cheng Lai","doi":"10.1186/s41479-025-00168-w","DOIUrl":"10.1186/s41479-025-00168-w","url":null,"abstract":"<p><strong>Background: </strong>This real-world study aimed to assess the effectiveness of novel oral antiviral agents in managing COVID-19 among high-risk patients during the Omicron JN.1 subvariant wave.</p><p><strong>Methods: </strong>Data from the TriNetX US network were analyzed using a multi-institutional propensity score matching (PSM) analysis. High-risk non-hospitalized adults with COVID-19 were included, and patients receiving oral antiviral agents (study group) were compared to those not receiving antiviral agents (control group). Primary outcomes included all-cause emergency department (ED) visits, hospitalizations, or death within 30 days.</p><p><strong>Results: </strong>Among 67,495 high-risk patients identified, 17,852 received oral antiviral agents (study group) and 49,643 did not (control group). After PSM, two matched cohorts of 17,847 patients each were established. The study group receiving antiviral agents exhibited a significantly lower risk of primary composite outcome during the 30-day follow-up period compared to the control group (HR, 0.77; 95% CI, 0.72-0.84). Regarding the secondary outcomes, the study group consistently exhibited a significantly lower risk of all-cause ED visits (4.2% vs. 5.4%; HR, 0.78; 95% CI, 0.71-0.86), hospitalization (2.8% vs. 3.3%; HR, 0.86; 95% CI, 0.77-0.97), and mortality (0.1% vs. 0.3%; HR, 0.17; 95% CI, 0.08-0.35) than the control group. Subgroup analyses showed consistent benefits across various demographic and clinical characteristics, except in individuals with booster vaccination.</p><p><strong>Conclusions: </strong>Oral antiviral agents significantly reduced the risk of adverse outcomes among high-risk COVID-19 patients during the Omicron JN.1 subvariant wave. These findings support the potential benefits of oral antiviral therapy in treating COVID-19, particularly in high-risk populations.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"17 1","pages":"12"},"PeriodicalIF":8.5,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143858","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}