Severe community-acquired pneumonia - clinical management and challenges.
DOI:
https://doi.org/10.52692/1857-0011.2025.3-83.12Keywords:
severe community-acquired pneumonia, etiology, prognostic scores, lethalityAbstract
Severe community-acquired pneumonia is associated with increased medical cost and risk of mortality. Clinical, prognostic aspects and challenges in clinical management were analyzed by evaluating 1379 patients with community- acquired pneumonia, hospitalized in the pre-pandemic period (2013-2019) in the “Chiril Draganiuc” Pneumological Institute. Currently, there are still a series of controversies regarding severity scores, etiology and management aspects, predictors of unfavorable evolution.
References
Bauer TT, Welte T, Ernen C et al. Cost analyses of community-acquired pneumonia from the hospital perspective. Chest, 2005;128(4):2238-46.
Botnaru V, Rusu D. Protocolul clinic național „Pneumonia comunitară la adult”. Chișinău, 2008, ediția III anul 2022.
Cavallazzi R, Furmanek S, Arnold FW, Beavin LA, Wunderink RG, Niederman MS, Ramirez JA. The Burden of Community-Acquired Pneumonia Requiring Admission to ICU in the United States. Chest. 2020 Sep;158(3):1008-1016.
Chalmers JD, Mandal P, Singanayagam A, et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med, 2011;37:1409–1420.
Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis, 2008;47:375–384.
Cilloniz C, Dominedo C, Garcia-Vidal C, Torres A. Community-acquired pneumonia as an emergency condition. Curr Opin Crit Care, 2018;24:531–539.
Cilloniz C, Ferrer M, LiapikouA, et al. Acuterespiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia. Eur Respir J 2018; 51: 1702215.
Ebrahimi F, Giaglis S, Hahn S, et al. Markers of neutrophil extracellular traps predict adverse outcome in community-acquired pneumonia: secondary analysis of a randomised controlled trial. Eur Respir J, 2018; 51:1701389.
Ferrer M, Travierso C, Cilloniz C, et al. Severe community-acquired pneumonia: characteristics and prognostic factors in ventilated and non-ventilated patients. PLoS One, 2018; 13: e0191721.
Gaillat J, Bru JP, Sedallian A. Penicillin G/ofloxacin versus erythromycin/amoxicillin-clavulanate in the treatment of severe community-acquired pneumonia. Eur J Clin Microbiol Infect Dis, 1994; 13: 639–644.
Garnacho-Montero J, Barrero-Garcia I, Gomez- Prieto MG, et al. Severe community-acquired pneumonia: current management and future therapeutic alternatives. Expert Rev Anti Infect Ther, 2018;16:667–677.
Gattarello S, Borgatta B, Solé-Violán J et al. Decrease in mortality in severe community-acquired pneumococcal pneumonia: impact of improving antibiotic strategies (2000–2013). Chest, 2014;146(1):22-31.
Gonçalves-Pereira J1, Pereira J M, Ribeiro O, et al. Impact of infection on admission and of the process of care on mortality of patients admitted to the Intensive Care Unit: the INFAUCI study. Clin Microbiol Infect, 2014;20(12):1308-15.
Jain S, Self WH, Wunderink RG, et al. Community- acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med, 2015;373: 415–427.
Jones BE, Ying J, Stevens V, et al. Empirical anti- MRSA vs standard antibiotic therapy and risk of 30- day mortality in patients hospitalized for pneumonia. JAMA Intern Med, 2020; 180: 552–560.
Kolditz M, Ewig S, Klapdor B, et al. Community- acquired pneumonia as medical emergency: predictors of early deterioration. Thorax 2015; 70: 551–558.
Kumar A, Ellis P., Arabi Y et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest, 2009;136(5):1237-1248.
Laporte L, Hermetet C, Jouan Y, et al. Ten-year trends in intensive care admissions for respiratory infections in the elderly. Ann Intensive Care, 2018;8:84.
Lee JH, Kim HJ, Kim YH. Is beta-lactam plus macrolide more effective than beta-lactam plus fluoroquinolone among patients with severe community-acquired pneumonia: a systemic review and meta-analysis. J Korean Med Sci, 2017;32:77–84.
Lim HF, Phua J, Mukhopadhyay A, et al. IDSA/ATS minor criteria aid pre-intensive care unit resuscitation in severe community-acquired pneumonia. Eur Respir J, 2014;43:852–862.
Martin-Loeches I, Lisboa T, Rodriguez A, et al. Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia. Intensive Care Med 2010; 36: 612–620.
Martin-Loeches I, Schultz MJ, Vincent JL, et al. Increased incidence of co-infection in critically ill patients with influenza. Intensive Care Med, 2017;43:48–58.
Martin-Loeches I, Torres A, Nagavci B, et al. ERS/ ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Eur Respir J, 2023; 61.
Maruyama T, Fujisawa T, Ishida T, et al A therapeutic strategy for all pneumonia patients: a 3-year prospective multicenter-cohort study using risk factors for multidrug resistant pathogens to select initial empiric therapy. Clin Infect Dis, 2018; 19;68(7):1080- 1088.
Meduri GU, Shih M-C, Bridges L, et al. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med, 2022; 48: 1009–1023.
Mendez R, Menendez R, Cilloniz C, et al. Initial inflammatory profile in community-acquired pneumonia depends on time since onset of symptoms. Am J Respir Crit Care Med, 2018;198:370–378.
Montull B, Menendez R, Torres A, et al. Predictors of severe sepsis among patients hospitalized for community-acquired pneumonia. PLoS ONE, 2016; 1:e0145929.
Mortensen EM, Restrepo MI, Anzueto A, et al. The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia. J Crit Care, 2005; 10: R8.
Osler W. The principles and practice of medicine. Designed for the use of practitioners and students of medicine, 1892.
Pereira JM, Goncalves-Pereira J, Ribeiro O, et al Impact of antibiotic therapy in severe community- acquired pneumonia: data from the Infauci study. J Crit Care, 2018;43:183–189.
Piralla A, Rovida F, Girello A, et al. Frequency of respiratory virus infections and next-generation analysis of influenza A/H1N1pdm dynamics in the lower respiratory tract of patients admitted to the ICU. PLoS ONE, 2017;12:e0178926.
Postma DF, van Werkhoven CH, van Elden LJ, et al. Antibiotic treatment strategies for community- acquired pneumonia in adults. N Engl J Med, 2015;372:1312–1323.
Ranzani OT, Prina E, Menendez R, et al. New sepsis definition (sepsis-3) and community-acquired pneumonia mortality. A validation and clinical decision-making study. Am J Respir Crit Care Med, 2017;196:1287–1297.
Rouzé A, Martin-Loeches I, Povoa P, et al. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med, 2021; 47: 188–198.
Salih W, Schembri S, Chalmers JD. Simplification of the IDSA/ATScriteria for severe CAP using meta- analysis and observational data. Eur Respir J, 2014;43:842–851.
Shindo Y, Ito R, Kobayashi D. Risk factors for drug- resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2013;188:985–995.
Torres A, Chalmers JD., Dela Cruz CS. et al. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Med, 2019; 45:159–171.
Waterer G. Severity scores and community-acquired pneumonia. Time to move forward. Am J Respir Crit Care Med, 2017; 196:1236–1238.
Waterer GW, Self WH, Courtney DM, et al. In-hospital deaths among adults with community-acquired pneumonia. Chest, 2018; 154:628–635.
Webb BJ, Sorensen J, Mecham I, et al. Antibiotic use and outcomes after implementation of the drug resistance in pneumonia score in ED patients with community-onset pneumonia. Chest, 2019; 156: 843–851.
Wilson BZ, Anzueto A, Restrepo MI, et al. Compar- ison of two guideline-concordant antimicrobial com- binations in elderly patients hospitalized with severe community-acquired pneumonia. Crit Care Med, 2012; 40: 2310–2314.
Woodhead M, Welch CA, Harrison DA, et al. Community-acquired pneumonia on the intensive care unit: secondary analysis of 17,869 cases in the ICNARC Case Mix Programme Database. Crit Care, 2006; 10 (Suppl 2):S1.
Wunsch H, Angus DC, Harrison Daet al. Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med, 2011;183:1666–1673.
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