Corticosteroid use does not appear to increase infectious complications in non-COVID-19 pneumonia

A systematic review and meta-analysis evaluated the association between corticosteroid therapy, mortality, and infectious complications in adults with severe non-COVID-19 pneumonia or acute respiratory distress syndrome (ARDs). The review found that adjunct corticosteroids probably reduce short-term mortality in cases of severe pneumonia and ARDS and may reduce secondary shock in severe pneumonia. The findings are published in Annals of Internal Medicine.

Researchers from Hôpital La Pitié Salpêtrière and Sorbonne University analyzed 20 randomized controlled trials comprising 3,459 participants that compared systemic corticosteroids with placebo and usual care.

The primary analysis included studies using corticosteroids at 3 mg/kg or less per day, for 15 days or less, initiated within 7 days of pneumonia or ARDS onset. The review found that adjunct corticosteroids probably reduce short-term mortality in both severe pneumonia and ARDs, but evidence for their effect on long-term mortality remains uncertain. In severe pneumonia, they may reduce secondary shock but have little effect on hospital-acquired infections and secondary pneumonia in both severe pneumonia and ARDs.The evidence is very uncertain about the effect on catheter-related infections in both conditions.

The findings suggest that there is no evidence of increased infectious complications with corticosteroid use for pneumonia, which is one of the main concerns regarding corticosteroid use for non-COVID-19 pneumonia.

Reference:

Alice Soumare, Thomas Kapfer, Thomas Botrel, et al. Systemic Corticosteroids, Mortality, and Infections in Pneumonia and Acute Respiratory Distress Syndrome: A Systematic Review and Meta-analysis. Ann Intern Med. [Epub 2 December 2025]. doi:10.7326/ANNALS-25-03055