Impact of Systemic Corticosteroids on Antibiotic Days of Therapy in Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia Samantha Saraceno, Zoanne Harlas, Joseph Crosby, Ryan Sarvestani, John Carr St. Joseph/Candler Health System Background/Purpose: Clinical outcomes related to the use of systemic corticosteroids are not well defined in hospital-acquired pneumonia and ventilator-associated pneumonia (HAP/VAP) patients. Much of the available evidence is extrapolated from research and guidelines on community-acquired pneumonia (CAP). However, HAP and VAP are fundamentally different from CAP and are associated with significantly higher morbidity and mortality. Studies have suggested long-term use of corticosteroids prior to developing HAP/VAP can increase mortality, antibiotic days of therapy and days of mechanical ventilation. The purpose of this study was to determine whether the use of corticosteroids is associated with prolonged need for antimicrobial therapy in patients with HAP/VAP.
Methodology: This was a retrospective, cohort study. We looked at two groups, those who received systemic corticosteroids during treatment and those who did not. Adult patients diagnosed with HAP/VAP based on ICD10 codes were included. Exclusion criteria included pregnancy, multiple sources of infection, viral or fungal pneumonia, those who were immunocompromised, neutropenia and long-term steroid use at baseline. The primary outcome was the number of days free from antibiotics. Secondary outcomes included number of days free from mechanical ventilation, incidence of multi-drug resistant infection, hospital length of stay and in-hospital mortality. Continuous measures were analyzed by mean and standard deviation, and a t-test was used to determine p-value. For intermittent measures, percentages were calculated, and chi-square tests were used to analyze data. Statistical significance was determined as a p-value < 0.05.
Results: 116 patients were screened, with 81 being excluded and 35 meeting inclusion criteria. There were 15 patients included in the corticosteroid group and 20 patients included in the no corticosteroid group. The primary outcome was not statistically significant with number of days free from antibiotics being 15.98 days in the steroid group and 11.2 days in the without steroids group, resulting in a p-value of 0.087. The secondary outcome of number of days free from mechanical ventilation showed statistical significance with the steroid treatment group having a mean of 7.65 days on mechanical ventilation compared to the without steroids group having a mean of 15.92 days, resulting in a p-value of 0.035. All other outcomes showed no statistical significance with no p-values > 0.05.
Conclusion: For patients diagnosed with HAP/VAP, treatment involving corticosteroids had no impact on duration of antibiotic therapy compared to those who did not receive corticosteroids. Thus, systemic corticosteroids may have little to no impact on duration of antibiotic therapy in this patient population. Patients diagnosed with HAP/VAP who are mechanically ventilation may have a shorter duration of ventilation if systemic corticosteroids are used as part of therapy. Further research is needed to confirm these preliminary findings.
