Hospitalized Adults With Community-Acquired Pneumonia Suffer Significant Morbidity Post Discharge

Adults hospitalized for community-acquired pneumonia are at high risk of losing the ability to perform basic and instrumental activities of daily living (ADLs), losing their employment status, and experiencing poor quality of life (QoL) at 6 months post discharge compared with their preillness statuses, according to the results of a prospective cohort study published in BMC Infectious Diseases.¹

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Community-Acquired Pneumonia Can Cause Major Postinfection Burdens

Pneumonia presents a major global disease burden, determined as the fourth-leading cause of death worldwide. CAP, often caused by infection with Streptococcus pneumoniae, is especially burdensome and is more complex to track and treat given that the infection is spread in community settings rather than a hospital or other health care facility.^2,3

The recent COVID-19 pandemic and the long-term effects that some patients infected with SARS-CoV-2 experience have shed light on the potential for acute respiratory infections to cause severe long-term morbidity. Aspects of this can include the loss of ability to perform ADLs, cognitive impairment, and poor quality of life for months to years following their illness. Despite the universal recognition of CAP's burden on patients, there remains a lack of understanding of the long-term morbidity associated with CAP.^1,4

Evidence has emerged in other infectious disease sectors, including influenza and respiratory syncytial virus, that an acute infection can negatively impact QoL and cause immense physical disability and difficulties with employment. To this point, there have been few studies that have evaluated the risk factors for long-term morbidity for non-COVID-19 pneumonia; elucidating these factors could aid providers in better developing strategies to prevent or mitigate dysfunction and disability following infection.¹

Poor Preillness State Considered Significant Risk Factor for CAP

Accordingly, the current investigators initiated a study to characterize the burden of a series of long-term morbidities 6 months following hospitalization for CAP, including loss in the ability to perform basic and instrumental ADLs, cognitive impairment, loss of employment, and decreased quality of life, while aiming to identify risk factors associated with these long-term morbidities. Investigators utilized data from the Pneumococcal Pneumonia Epidemiology, Urine Serotyping, and Mental Outcomes (PNEUMO) study, a multicenter, prospective observational trial that focused on the epidemiology of CAP.^1,5

Across the 2-year enrollment period for the analysis, 1286 patients were enrolled, and following the exclusion of some, 296 patients were available for inclusion. The authors found that, at 6 months and compared with preillness status, 12.8% of patients hospitalized with CAP lost their ability to perform at least 1 basic ADL, 22.8% lost the ability to perform at least 1 instrumental ADL, 58.7% had a loss of employment, and 23.6% had a poorer quality of life. Furthermore, 41.6% met criteria for cognitive impairment; such impairment was identified in 40.1% of patients without a history of dementia and 37.5% of patients who were aged less than 60 years, according to the authors.¹

The authors also examined the relationship between specific risk factors and outcomes 6 months after CAP hospitalization. They found that fewer years of education, female sex, and preillness dementia were meaningfully associated with a lower 6-month Barthel index, indicating a poorer ability to perform basic ADLs. Additionally, female sex, previous tobacco use, and current tobacco use were found to be significantly associated with lower 6-month QoL.¹

Implications for Pharmacists

Overall, a lower preillness ability to perform instrumental ADLs, poorer preillness QoL, lower educational attainment, and tobacco use were some of the main risk factors associated with long-term morbidity following CAP hospitalizations. The authors called for new strategies to prevent these factors associated with CAP in high-risk patients, both during and after hospitalization. Interventions that may be useful based on these data include intensive physical, occupational, and speech therapy during and following hospitalization.¹

Pharmacists stand to play a critical role in this regard. As one of the most front-facing health care providers for patients, pharmacists are uniquely positioned to monitor and observe patients for potential risk factors that could make CAP severe.

REFERENCES

1. Han JH, Resser JJ, Baughman A, et al. Community-acquired pneumonia in hospitalized adults: Long-term morbidities and their risk factors. BMC Infectious Diseases. 2025;25(826). doi:10.1186/s12879-025-11186-w

2. World Health Organization. The top 10 causes of death. Published August 7, 2024. Accessed July 2, 2025. https://www.who.int/en/news-room/fact-sheets/detail/the-top-10-causes-of-death

3. Blaivas AJ, Dugdale DC, Conaway B. Community-acquired pneumonia in adults. MedlinePlus. Last Reviewed August 19, 2024. Accessed July 2, 2025. https://medlineplus.gov/ency/article/000145.htm

4. Admon AJ, Iwashyna TJ, Kamphuis LA, et al. Assessment of symptom, disability, and financial trajectories in patients hospitalized for COVID-19 at 6 months. JAMA Netw Open. 2023;6(2):e2255795. doi:10.1001/jamanetworkopen.2022.55795

5. Self WH, Johnson KD, Resser JJ, et al. Prevalence, clinical severity, and serotype distribution of pneumococcal pneumonia among adults hospitalized with community-acquired pneumonia in Tennessee and Georgia, 2018-2022. Clin Infect Dis. 2024;79(4):838-847. doi:10.1093/cid/ciae316