Management of community-acquired pneumonia in adults

Grant W. Waterer, Jordi Rello, Richard G. Wunderink

Research output: Contribution to journalShort surveypeer-review

82 Scopus citations

Abstract

Despite many advances in medical science, the mortality rate from community-acquiredpneumonia (CAP) has changed little in the past four decades. Death and adverse outcomes from CAP result from a complex interplay between the pathogen and the host. Newer information about the effect of pneumonia on comorbidity and underlying diseases, especially long term, suggests this is an important additional axis that differs from the traditional triangular concept of pathogen, host defense, and antibiotic treatment. A number of clinical scoring systems have been developed to help physicians identify patients with CAP at risk of adverse outcomes. None of the criteria have been prospectively demonstrated to avoid late intensive care unit transfers or lower mortality, raising interest in the use of biomarkers such as procalcitonin. Quantitative bacterial genomic load represents a potentially important risk stratification. Optimal antibiotic management appears to include use of a macrolide, although the mechanism of benefit remains unclear. Attempts to improve CAP outcomes through setting measurable process of care standards are to be applauded, but making sure that these standards do not become the end in themselves, but rather that the entire process of care is improved, remains critical.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Volume183
Issue number2
DOIs
StatePublished - Jan 15 2011

Keywords

  • Antibiotics
  • Biomarkers
  • Intensive care unit
  • Pneumonia
  • Process of care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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