Biological sex is a major cause of heterogeneity in the epidemiology, management response to therapies, and outcomes of respiratory diseases and other infections.
A new article, made available online on June 16, 2026, in the Journal of Intensive Medicine , is calling attention to how biological sex inequities contribute to suboptimal pneumonia management for women. Authored by Prof. Nicolas Garin, Prof. Virginie Prendki, Dr. Despoina Koulenti and Prof. Jordi Rello, the piece highlights overlooked clinical and management differences between men and women, and urges the integration of sex and gender into pneumonia management protocols in the hospital.
The study emphasizes that women often face both underrepresentation in diagnostic tests and higher risks of antibiotic underexposure. Hormonal fluctuations, body composition, and renal clearance all influence how drugs are processed, yet these variables are rarely considered in dosing algorithms. Meanwhile, men—especially younger individuals with augmented renal clearance—may be underdosed, leading to treatment failure.
"Standard dosing overlooks key biological differences," said Prof. Garin. "Women, due to altered metabolism and lower muscle mass, are more vulnerable to adverse effects, while young men often eliminate drugs too quickly to maintain therapeutic levels," said Prof. Rello .
Beyond biology, gender roles and biases further complicate intensive medicine care. Women are less likely than men to receive aggressive or timely interventions, such as bronchoscopy, with disparities stemming from symptom misinterpretation, healthcare-seeking behaviors, or implicit bias within emergency systems.
These inequities compound the biological differences already influencing diagnosis and therapy. “Our findings point towards less aggressive life support measures in women,” said the authors. Standardized dosing often overlooks how women are more prone to suboptimal antibiotic use and adverse reactions, while younger men with augmented renal clearance face underdosing and treatment failure. Such imbalances highlight the urgency of tailoring antimicrobial therapy more precisely.
The authors advocate for wider use of diagnostic microbiological tests to individualize treatment and reduce both toxicity and resistance. They also call on the scientific community to integrate sex- and gender-aware research protocols, noting that fewer than 30% of studies currently report sex-stratified data.
In conclusion, Prof. Rello stated , "Understanding the differences shaped by sex and gender is essential to advancing personalized medicine and represents a commitment to reducing the equity gap."
Reference
DOI: https://doi.org/10.1016/j.jointm.2026.04.008
About Professor Nicolas Garin from Riviera-Chablais Hospital, Rennaz, and Geneva University Hospital, Switzerland.
Professor Nicolas Garin trained in internal medicine and clinical research at Geneva University Hospitals. He has been board-certified in internal medicine since 2007 and a Professor at the University of Geneva since 2019. He has been Head of the Department of Internal Medicine of Riviera-Chablais Hospital since 2016 and a consultant at Geneva University Hospitals. His main research interests encompass the diagnosis and treatment of pneumonia.
Website: https://www.hopitalrivierachablais.ch/
About University International of Catalonia (UIC), Barcelona, Spain
The UIC Barcelona Bachelor's Degree in Medicine has achieved accreditation from the World Federation for Medical Education ( WFME ), making UIC Barcelona the first private university in Spain to obtain this seal of international quality. This accreditation will allow medical students from UIC Barcelona to access the specialization process or work in the USA from 2024, at which time a regulatory change is planned that will prevent doctors from non-accredited faculties from being recognized in that country. In addition, this international seal will help UIC Barcelona medicine graduates to gain worldwide recognition as well as work internationally.
Website: https: https://www.uic.es/
About Nîmes University Hospital, Nîmes, France
The Nîmes University Hospital is one of the largest hospitals in France. The hospital has an excellent oncology department, anesthesia department, and intensive care units. The hospital also focuses on research-based innovations and actively runs clinical trials. It has a strong research organization performing translational research from bench to bedside. The institution also conducts training for health-care professionals on a regular basis. The hospital is affiliated with the University of Montpellier, in Southeast France.
Website: https://www.chu-nimes.fr/
About Professor Jordi Rello
Dr. Jordi Rello has an academic affiliation as Professor of Medicine at the University International de Catalonia (UIC) in Barcelona and as a Senior Researcher affiliated with the IMAGINE research group, led by Prof. JY Lefrant. He earned his PhD in Infectious Diseases at the University of Barcelona, Spain. His areas of research include studies on epidemiology of sepsis and severe pneumonia, treatment of infections in critically ill patients, immune senescence and the effect of aging in infections, and gender medicine. He has authored nearly 800 research articles. He has been awarded as Professor Honoris Causa by the University of Thesalia, in Larisa, Greece, in May 2026.
Journal of Intensive Medicine
Observational study
People
Ventilator-associated pneumonia in males and females: A post hoc analysis of the prospective multicenter multinational EUVAP cohort
16-Jun-2026
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.