Severe community-acquired pneumonia: optimal management.

Leoni, Davide; Rello, Jordi

PURPOSE OF REVIEW Community-acquired pneumonia (CAP) is the leading cause of mortality among infectious diseases. Several efforts have been implemented to achieve better outcomes, but an important proportion of patients continue dying. This review focuses on the newest research on prognostic factors and diagnostics, opening new perspectives in the management of CAP. RECENT FINDINGS CAP survival improved in recent years despite an increasing incidence of severe presentations. Appropriateness of antimicrobial choice, combination therapy and early administration of antibiotics has proved to be decisive. Novel biomarkers, as monocyte human leukocyte antigen-DR, presepsin and proadrenomedullin, have been explored for the prediction of severe CAP; moreover, the application of new techniques in metabolomics, genomics and microbiomics in the field of infections may contribute to predicting clinical instability and worse outcomes, showing that precise individual phenotypes are key factors for survival. CAP with unidentified organism is still an issue of concern, but new rapid molecular tests improve yield rates, revealing an unexpected high prevalence of viral detection and proving their usefulness also in the recognition of bacterial causes. SUMMARY Precision medicine applied to risk stratification and diagnosis, together with rapid microbiologic molecular testing, may contribute to optimizing the management of CAP, with potential additional reduction of mortality rates.