Pulmonary Histopathological Changes and Their Impact on Antibiotic Efficacy in Bacterial Pneumonia: A Systematic Review and Meta-analysis
Abstract
Background- Bacterial pneumonia remains one of the leading infectious causes of hospitalization, respiratory failure, and mortality
worldwide despite substantial advances in antimicrobial therapy and intensive care management [1,2]. Histopathological alterations
in the lung parenchyma such as diffuse alveolar damage, fibrinous exudation, neutrophilic infiltration, necrosis, and microabscess
formation may significantly influence antibiotic penetration, bacterial clearance, and tissue recovery [3–5]. However, the prognostic
relevance of these pathological changes in determining antibiotic response has not been comprehensively synthesized.
Objective- To systematically evaluate the association between histopathological lung findings and antibiotic response in patients
with bacterial pneumonia.
Methods- A systematic review and meta-analysis was conducted using studies retrieved from PubMed, Embase, Scopus, Web of
Science, and Cochrane Library databases from January 2000 to January 2026. Studies assessing histopathological lung changes and
antibiotic-related outcomes in bacterial pneumonia were included. Pooled odds ratios (ORs) and standardized mean differences
(SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Results- Twenty-eight studies involving 5,742 patients were included. Diffuse alveolar damage (OR 2.84, 95% CI 2.01–4.03),
necrotizing inflammation (OR 3.12, 95% CI 2.15–4.53), extensive neutrophilic infiltration (OR 1.96, 95% CI…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 5,742 participants or records.
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