Developments in pneumonia and priorities for research

Despite decades of advances in clinical management protocols and new antibiotics, pneumonia continues to be a leading cause of morbidity and mortality worldwide. The 2019 Global Burden of Disease Study indicated that lower respiratory infections, including pneumonia, were the fourth leading cause of disability-adjusted life-years across all ages. 1 Vos T Lim SS Abbafati C et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396: 1204-1222 Summary Full Text Full Text PDF PubMed Scopus (6069) Google Scholar People at the extremes of age, specifically children younger than 10 years and older adults (aged ≥75 years), had the highest burden of lower respiratory infections. 1 Vos T Lim SS Abbafati C et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396: 1204-1222 Summary Full Text Full Text PDF PubMed Scopus (6069) Google Scholar Pneumonia can be broadly divided into community-acquired pneumonia and hospital-acquired pneumonia, of which ventilator-associated pneumonia forms a subset. A substantial proportion of adult patients with community-acquired pneumonia require intensive care management due to severe disease and complications; 2 Jain S Self WH Wunderink RG et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015; 373: 415-427 Crossref PubMed Scopus (1479) Google Scholar and in-hospital mortality rates for severe community-acquired pneumonia in adults range from 20% to 30%. 3 Ferrer M Travierso C Cilloniz C et al. Severe community-acquired pneumonia: characteristics and prognostic factors in ventilated and non-ventilated patients. PLoS One. 2018; 13e0191721 Crossref Scopus (60) Google Scholar To guide the management of severe community-acquired pneumonia, international consensus guidelines have recently been published. 4 Martin-Loeches I Torres A Nagavci B et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med. 2023; 49: 615-632 Crossref PubMed Scopus (17) Google Scholar However, knowledge gaps remain in the treatment of pneumonia that should be addressed through targeted research. In this Comment, we highlight key unaddressed questions and priorities for research (panel). PanelOngoing studies on the management of pneumonia * Not an exhaustive list but some important areas of ongoing research. *Not an exhaustive list but some important areas of ongoing research.Reducing antibiotic treatment duration for pneumonia •Short-course antibiotic therapy of 5 days in community-acquired pneumonia (CAP5; NCT04089787) •Reducing antibiotic treatment duration for ventilator-associated pneumonia (REGARD-VAP; NCT03382548) •The duration of antibiotic therapy for early ventilator associated pneumonia (DATE): 4 days versus 7 days (NCT05545735) •Effect of steroids on outcomes in severe pneumonia: •Arrest respiratory failure from pneumonia (ARREST; NCT04193878) Biomarkers and pneumonia •Diagnostic and prognostic biomarkers for childhood bacterial pneumonia (NCT03996967) Rapid diagnostics in pneumonia: •Trial on a strategy combining rapid diagnostic testing and antimicrobial stewardship to improve antibiotic use in patients with hospital-acquired pneumonia (SHARP; NCT04153682) Combined use of biomarkers and rapid diagnostics in pneumonia •Combined use of a respiratory broad-panel multiplex PCR and procalcitonin to reduce duration of antibiotics exposure in patients with severe community-acquired pneumonia (MULTI-CAP; NCT03452826) Reducing antibiotic treatment duration for pneumonia •Short-course antibiotic therapy of 5 days in community-acquired pneumonia (CAP5; NCT04089787) •Reducing antibiotic treatment duration for ventilator-associated pneumonia (REGARD-VAP; NCT03382548) •The duration of antibiotic therapy for early ventilator associated pneumonia (DATE): 4 days versus 7 days (NCT05545735) •Effect of steroids on outcomes in severe pneumonia: •Arrest respiratory failure from pneumonia (ARREST; NCT04193878) Biomarkers and pneumonia •Diagnostic and prognostic biomarkers for childhood bacterial pneumonia (NCT03996967) Rapid diagnostics in pneumonia: •Trial on a strategy combining rapid diagnostic testing and antimicrobial stewardship to improve antibiotic use in patients with hospital-acquired pneumonia (SHARP; NCT04153682) Combined use of biomarkers and rapid diagnostics in pneumonia •Combined use of a respiratory broad-panel multiplex PCR and procalcitonin to reduce duration of antibiotics exposure in patients with severe community-acquired pneumonia (MULTI-CAP; NCT03452826)