Severe community-acquired pneumonia: Severity and management: Severe community-acquired pneumonia: Severity and management

Adamantia Liapikou; Catia Cilloniz

Authors

Adamantia Liapikou Sotiria Chest Diseases Hospital, Mesogion 152, 11527 Athens, Greece
Catia Cilloniz Department of Pneumology, Hospital Clinic, Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona, Barcelona, Spain

Keywords:

Intensive Care Unit, multidrug-resistant pathogens, prognostic scores, severe community-acquired pneumonia, therapy

Abstract

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. "Severe CAP'' (sCAP) identifies a group of patients who have severe disease and require Intensive Care Unit admission. Recommendations for antibiotic treatment for sCAP are based on illness severity, frequency of specific pathogens and local microbial resistance patterns. The challenges to patient management include the emergence of the high prevalence of multidrug-resistant in CAP, mainly from institutionalizing patients. A new approach is the evaluation of biomarkers as C-reactive protein, procalcitonin on the diagnosis, prognosis and therapy duration of sCAP with promising results . Implementation of guidelines for CAP treatment should be emphasized in order to increase survival. The benefits of steroid use in patients with severe pneumonia have not been proven yet by current literature.

References

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72.

Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections - Full version. Clin Microbiol Infect 2011;17 Suppl 6:E1-59.

Woodhead M, Welch CA, Harrison DA, Bellingan G, Ayres JG. Community-acquired pneumonia on the intensive care unit: Secondary analysis of 17,869 cases in the ICNARC Case Mix Programme Database. Crit Care 2006;10 Suppl 2:S1.

Chalmers JD, Mandal P, Singanayagam A, Akram AR, Choudhury G, Short PM, et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: Systematic review and meta-analysis. Intensive Care Med 2011;37:1409-20.

Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, et al. SMART-COP: A tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008;47:375-84.

España PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med 2006;174:1249-56.

Restrepo MI, Mortensen EM, Rello J, Brody J, Anzueto A. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest 2010;137:552-7.

Renaud B, Santin A, Coma E, Camus N, Van Pelt D, Hayon J, et al. Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia. Crit Care Med 2009;37:2867-74.

Ramírez P, Ferrer M, Martí V, Reyes S, Martínez R, Menéndez R, et al. Inflammatory biomarkers and prediction for intensive care unit admission in severe community-acquired pneumonia. Crit Care Med 2011;39:2211-7.

Menéndez R, Martínez R, Reyes S, Mensa J, Filella X, Marcos MA, et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax 2009;64:587-91.

Falguera M, Carratalà J, Ruiz-Gonzalez A, Garcia-Vidal C, Gazquez I, Dorca J, et al. Risk factors and outcome of community-acquired pneumonia due to Gram-negative bacilli. Respirology 2009;14:105-11.

Cillóniz C, Ewig S, Polverino E, Marcos MA, Esquinas C, Gabarrús A, et al. Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax 2011;66:340-6.

Aliberti S, Zanaboni AM, Blasi F. Pneumonia in the community caused by multidrug-resistant organisms: Keep working on probabilistic scores. Clin Infect Dis 2012;54:1519-20.

Shorr AF, Zilberberg MD, Reichley R, Kan J, Hoban A, Hoffman J, et al. Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department. Clin Infect Dis 2012;54:193-8.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228.

Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009;136:1237-48.

Bodí M, Rodríguez A, Solé-Violán J, Gilavert MC, Garnacho J, Blanquer J, et al. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: Impact of adherence to Infectious Diseases Society of America guidelines on survival. Clin Infect Dis 2005;41:1709-16.

Frei CR, Attridge RT, Mortensen EM, Restrepo MI, Yu Y, Oramasionwu CU, et al. Guideline-concordant antibiotic use and survival among patients with community-acquired pneumonia admitted to the intensive care unit. Clin Ther 2010;32:293-9.

Rodríguez A, Mendia A, Sirvent JM, Barcenilla F, de la Torre-Prados MV, Solé-Violán J, et al. Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock. Crit Care Med 2007;35:1493-8.

Restrepo MI, Mortensen EM, Waterer GW, Wunderink RG, Coalson JJ, Anzueto A. Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia. Eur Respir J 2009;33:153-9.

Martin-Loeches I, Lisboa T, Rodriguez A, Putensen C, Annane D, Garnacho-Montero J, et al. Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia. Intensive Care Med 2010;36:612-20.

Falguera M, Ruiz-González A, Schoenenberger JA, Touzón C, Gázquez I, Galindo C, et al. Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia. Thorax 2010;65:101-6.

Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004;170:440-4.

Martínez JA, Horcajada JP, Almela M, Marco F, Soriano A, García E, et al. Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2003;36:389-95.

Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients′ exposure to antibiotics in intensive care units (PRORATA trial): A multicentre randomised controlled trial. Lancet 2010;375:463-74.

Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids - New mechanisms for old drugs. N Engl J Med 2005;353:1711-23.

Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients. Eur Respir J 2015;45:463-72.

Snijders D, Daniels JM, de Graaff CS, van der Werf TS, Boersma WG. Efficacy of corticosteroids in community-acquired pneumonia: A randomized double-blinded clinical trial. Am J Respir Crit Care Med 2010;181:975-82.

Nie W, Zhang Y, Cheng J, Xiu Q. Corticosteroids in the treatment of community-acquired pneumonia in adults: A meta-analysis. PLoS One 2012;7:e47926.

Confalonieri M, Annane D, Antonaglia C, Santagiuliana M, Borriello EM, Meduri GU. Is prolonged low-dose glucocorticoid treatment beneficial in community-acquired pneumonia? Curr Infect Dis Rep 2013;15:158-66.

Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A. Noninvasive ventilation in severe hypoxemic respiratory failure: A randomized clinical trial. Am J Respir Crit Care Med 2003;168:1438-44.

Severe community-acquired pneumonia: Severity and management