Community-acquired pneumonia

Abstract

Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria. New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising. Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events. Studies are needed that focus on the long-term management of pneumonia.

Figure 1

Microbiological investigations ICU=intensive care unit. *Others indicates fungal, tuberculosis cultures, PCR, specific serology, lung biopsy.

Figure 2

Acute management of the community-acquired pneumonia CAP=community-acquired pneumonia. CURB-65=Confusion Urea Respiratory rate Blood pressure and age ≥65 year old score. PSI=Pneumonia Severity Index. ICU=intensive care unit. *Combination with macrolide is preferred.

Figure 3

Acute and long-term assessment of community-acquired pneumonia