Secular Trends in the Management of Severe Community-Acquired Bacterial Pneumonia in the US

Presenter: Zilberberg, Marya

This study compared characteristics, ventilatory strategies, and outcomes in patients with severe community-acquired bacterial pneumonia (sCABP) across two periods: a historic cohort (2010–2015) and a contemporary post-COVID-19 cohort (2021–2024). sCABP was defined using IDSA/ATS criteria requiring respiratory and/or circulatory support.

The prevalence of sCABP increased from 14.1% in the historic cohort (HC) to 19.1% in the contemporary cohort (CC). Compared to HC (N=21,805), patients in CC (N=52,618) were slightly older (69.1±13.4 vs 67.6±15.1 years), less often male (49.7% vs 51.7%), and had lower comorbidity burden (Charlson score 3.5±2.3 vs 4.4±2.8).

Markers of illness severity and resource use were lower in the contemporary cohort, with fewer patients requiring early ICU admission (37.4% vs 89.5%) or vasopressors (15.8% vs 60.3%). Use of invasive mechanical ventilation (IMV) declined substantially (71.6% vs 20.9%), while non-invasive ventilation increased (25.9% vs 73.6%). Only 8.2% of patients in the contemporary cohort met sCABP criteria based solely on high-flow oxygen use. Hospital mortality decreased from 22.0% in HC to 15.0% in CC.

These findings indicate a shift toward less invasive respiratory support in sCABP management, accompanied by reduced mortality, although outcomes remain suboptimal.

Critical Care Congress 2026, March 22-24, Chicago