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March 26, 2026

374: Secular Trends in the Management of Severe Community-Acquired Bacterial Pneumonia in the Us

Puntos clave

The study aims to evaluate changes in the management of severe community-acquired bacterial pneumonia during two distinct time periods.
Analyzed data from Premier Healthcare Database for two cohorts: 2010-2015 and 2021-2024.
Used ICD-9/10 codes to identify severe community-acquired bacterial pneumonia cases.
Compared baseline characteristics, management strategies, and mortality rates between cohorts.
Prevalence of severe community-acquired bacterial pneumonia increased from 14.1% to 19.1%.
Use of invasive mechanical ventilation decreased from 71.6% to 20.9%; non-invasive ventilation rose from 25.9% to 73.6%.
Hospital mortality reduced from 22.0% to 15.0%.

Resumen

Introduction: Severe community-acquired bacterial pneumonia (sCABP) often leads to acute hypoxemic respiratory failure (AHRF). During the COVID-19 pandemic the management of AHRF evolved away from the use of invasive mechanical ventilation (IMV) and towards less invasive modes. It is unclear if these adjustments to practice are used in the current management of sCABP. Methods: We evaluated the baseline characteristics, ventilatory management, and mortality of patients with sCABP during two different time periods: years 2010-2015 as reported by Haessler et al historic cohort, HC 1, and the post-COVID-19 pandemic era (2021-2024) contemporary cohort, CC. Both cohorts derived from the Premier Healthcare Database. Both studies employed an ICD-9/10 code-based algorithm for the diagnosis of CABP, and both defined sCABP based on the Infectious Diseases Society of America/American Thoracic Society guidelines which require either respiratory or circulatory support or both. Results: Among patients with CABP, the prevalence of sCABP was 14.1% in HC and 19.1% in CC. Compared to HC (N=21,805), sCABP patients in CC (N=52,618) were slightly older (69.1±13.4 vs. 67.6±15.1 years), less likely male (49.7% vs. 51.7%), and less chronically ill (Charlson score 3.5±2.3 vs. 4.4±2.8). Fewer patients in CC required early ICU admission (37.4% vs. 89.5%) or vasopressors (15.8% vs. 60.3%). The use of IMV decreased from 71.6% in HC to 20.9% in CC, while non-invasive ventilation rose from 25.9% in HC to 73.6% in CC. Only a small minority of those in CC met the definition for sCABP based solely on application of high-flow oxygen (8.2%). Hospital mortality decreased from 22.0% in HC to 15.0% in CC. Conclusions: Over the past decade, sCABP management has evolved. While the patients at baseline remain similar in age and gender, and appear only slightly less chronically ill, the use of IMV, vasopressors, and early ICU care has diminished substantially. Hospital mortality has also decreased, though it remains unacceptably high. These changes may reflect clinicians’ improved comfort with and preference for non-invasive respiratory support following extensive experience with COVID-19-related AHRF. 1 Haessler S et al. Crit Care Med 2022;50:1063-1071

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