Corticosteroid Treatment for Community-Acquired Pneumonia - The STEP Trial

Inclusion criteria

• Patients 18 years of age or older admitted for hospitalization from the community or a nursing home with CAP.
• CAP will be defined by a new infiltrate on chest radiograph and the presence of one or several of the following acute respiratory signs or symptoms:

• cough
• sputum production
• dyspnea
• core body temperature >38.0° C
• auscultatory findings of abnormal breath sounds and rales
• leukocyte count >10 or <4 x 109 cells L-1 (1)

Exclusion criteria

• Patients or family members unable to give written informed consent, e.g. with severe dementia.
• Patients with active intravenous drug use.
• Severe immunosuppression (e.g. patients infected with human immunodeficiency virus infection and a CD4 count below 350 x 109/L, patients on immunosuppressive therapy after solid organ transplantation and neutropenic patients with neutrophil count < 500 x 109/L and patients under chemotherapy with neutrophils 500-1000 x 109/L with an expected decrease to values < 500 x 109/L); patients with cystic fibrosis as well as patients with active tuberculosis.
• Patients with acute burn injury
• Patients with acute gastrointestinal bleeding within 3 months of the current hospitalization
• Patients with an acute concomitant condition requiring more than 0.5mg/kg/d prednisone equivalent
• Pregnancy or breast feeding
• Patients with known adrenal insufficiency