Community Acquired Pneumonia

Wunderink, Richard G.; Landmeier, Mark W.

Early identification of patients with severe community-acquired pneumonia (CAP) who require ICU care is important as delayed transfer is associated with increased mortality. In such patients, aggressive diagnostic testing is warranted given the increased probability of detecting a pathogen resistant to usual empirical therapy. In the absence of risk factors for healthcare-associated pneumonia or drug resistant pathogens, adequate coverage of Streptococcus pneumoniae and Legionella pneumophila is crucial. When Pseudomonas is suspected, dual anti-pseudomonal therapy is required. When methicillin-resistant Staphylococcus aureus is suspected, linezolid is superior to vancomycin. Several aspects of managing severe CAP remain without consensus and include the risks associated with multidrug resistant pathogens, antibiotic use to suppress toxin formation in the setting of pneumonia caused by S. aureus, and adjuvant assessment tools such as procalcitonin.