Severe community-acquired pneumonia.

PURPOSE OF REVIEW: Community-acquired pneumonia remains a prevalent and potentially life-threatening infection. In general, the disease is considered severe when inpatient care including ICU admission is required, and this often suggests a poorer prognosis. Severe community-acquired pneumonia continues to be an important subject of research from different perspectives, including assessment of illness severity, etiology, diagnostic tests, and treatment options. The aim of this descriptive review is to comment on the results of the relevant original articles in this area published since April 1, 2003.

RECENT FINDINGS: The main themes in the literature covered by the review include the time course of serum concentrations of different markers of the inflammatory response, validation of severity scores to optimize hospital and ICU admission, outcome improvement (duration of therapy and optimal dosing, time to antibiotic administration, adequate initial treatment, and the impact of positive microbiological diagnosis on management and prognosis), and the efficacy of new antimicrobials.

SUMMARY: The usefulness of inflammatory markers to assess the outcome of the disease is unclear. Data on severity scores are conclusive and different validated and simple predictive rules are available for the classification of patients into risk classes. Therapeutic strategies that have been investigated confirm the impact of adequate empiric antibiotic treatment on clinical outcome and the equivalence between short and long courses in the duration of therapy. A definitive beneficial effect of early administration of antimicrobials or the knowledge of the etiology of pneumonia on the clinical course of the disease has not been demonstrated.