Severe community-acquired pneumonia in the post COVID-19 era

Abstract

Purpose of review The aim was to examine and summarize the most recent published literature in the last years stating the advances for treatment options and adjunctive therapies in patients hospitalized with severe community-acquired pneumonia (sCAP). Search was performed in PubMed, including observational studies, randomized controlled trials, systematic reviews and meta-analyses, and international guidelines. Recent findings Regardless of a large number of published CAP guidelines, most of their recommendations are based on low-level evidence. Viruses have an increasing role as sCAP etiology with an impact on mortality. Accordingly, it is imperative to strengthen the demand for vaccines and newer antivirals. Considering an early monitoring of the immune response in patients with severe Influenza, may help to evaluate a personalized immunomodulatory strategy. Despite growing evidence, the use of corticosteroids as an adjunctive therapy in bacterial sCAP continues to be controversial. Summary Mortality due to sCAP still remains undesirably high. This fact strengthens the need for more high-quality research to increase evidence. It also highlights the need for clinicians to be aware of the level of evidence of the stated recommendations, taking this into consideration before decision making.

Severe Legionnaires’ disease

“…The proportion of Lp among the causative agents of community-acquired pneumonia (CAP) was estimated to be 4.6% in a recent meta-analysis [14], and nearly twice this figure in patients admitted to the ICU. Historically, it has been reported to be one of the three most common causes of severe CAP requiring ICU admission [15][16][17][18], although advances in prevention, early detection and early appropriate therapy have reduced its incidence as a cause of ICU admission over the last decade [19,20]. LD may be a cause of severe hospital-acquired pneumonia [21] but there is no evidence to suggest a role in aspiration pneumonia [22].…”

At the Intersection of Critical Care and Infectious Diseases: The Year in Review

“…Severe infection leads to substantial morbidity and mortality. For example, community-acquired pneumonia (CAP) remains a leading cause of hospitalization with an estimated 7–10% of patients dying while hospitalized [ 1 ]. Likewise, in community-onset septic shock, the average length of stay (LOS) in the United States approaches 10 days and results in costs exceeding USD 75,000 per case [ 2 ].…”