Severe community-acquired pneumonia

Authors: Jakubec P.
Authors‘ workplace: Klinika plicních nemocí a tuberkulózy LF UP a FN Olomouc
Published in: Kardiol Rev Int Med 2019, 21(3): 129-134


Community-acquired pneumonia is an acute infection of the pulmonary alveoli, respiratory bronchioles, and interstitium, which is acquired in a common environment (community). It is one of the most common infectious diseases worldwide. Severe community-acquired pneumonia is the most serious form of the disease and is associated with significant morbidity and mortality, especially in elderly, immunocompromised and severe comorbid patients. Initially, it is important to stratify the risk of illness and decide on an adequate place of care, preferably in an intensive care unit. The cornerstone of treatment is timely and adequate antibiotic treatment, treatment of acute respiratory failure and sepsis. The disease is accompanied by a number of complications, of which heart disease is one of the most common. Even now, the disease has a serious progression and often a poor prognosis, especially in risk groups of patients.


severe community-acquired pneumonia – risk stratification – dia­gnostics – complications


1. Restrepo MI, Anzueto A. Severe com­munity--acquired pneumonia. Infect Dis Clin North Am 2009; 23(3): 503– 520. doi: 10.1016/ j.idc.2009.04.003.

2. Ananda-Rajah MR, Charles PG, Melvani S et al. Compar­­ing the pneumonia severity index with CURB-65 in patients admitted with com­munity acquired pneumonia. Scand J Infect Dis 2008; 40(4): 293– 300. doi: 10.1080/ 00365540701663381.

3. Renaud B, Santin A, Coma E 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(11): 2867– 2874. doi: 10.1097/ CCM.0b013e3181b02dbb.

4. Mandell LA, Wunderink RG, Anzueto A et al. IDSA/ ATS consensus guidelines on the management of com­munity-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl 2): S27– S72. doi: 10.1086/ 511159.

5. British Thoracic Society Standards of Care Com­mittee. BTS guidelines for the management of com­munity acquired pneumonia in adults. Thorax 2001; 56 (Suppl 4): 1– 64. doi: 10.1136/ thorax.56.suppl_4.iv1.

6. Bauer, TT, Ewig, S, Mar­re R et al. CRB-65 predicts death from com­munity-acquired pneumonia. J Intern Med 2006; 260(1): 93– 101. doi: 10.1111/ j.1365-2796.2006.01657.x.

7. Marti C, Garin N, Grosgurin O et al. Prediction of severe com­munity-acquired pneumonia: a systematic review and meta-analysis. Crit Care 2012; 16(4): R141. doi: 10.1186/ cc11447.

8. Li HY, Guo Q, Song WD et al. Priority for treatment and intensit care of patients with non-severe com­munity-acquired pneumonie. Am J Med Sci 2018; 356(4): 329– 334. doi: 10.1016/ j.amjms.2018.08.002.

9. West FM, Awsare BK. Putt­­ing the CAP on ICU admis­sions: can clinical prediction tools help determine appropriate site of care? Am J Med Sci 2018; 356(4): 313– 314. doi: 10.1016/ j.amjms.2018.08.007.

10. Guo Q, Song WD, Li HY et al. Scored minor criteria for severe com­munity-acquired pneumonia predicted better. Respir Res 2019; 20(1): 22. doi: 10.1186/ s12931-019-0991-4.

11. Karhu J, Ala-Kokko TI, Ohtonen P et al. Severe com­munity-acquired pneumonia treated with beta-lactam-respiratory quinolone vs. beta-lactam-macrolide combination. Acta Anaesthesiol Scand 2013; 57(5): 587– 593. doi: 10.1111/ aas.12081.

12. Ewig S, Woodhead M, Tor­res A. Towards a sensible comprehension of severe com­munity-acquired pneumonia. Intensive Care Med 2011; 37(2): 214– 223. doi: 10.1007/ s00134-010-2077-0.

13. Jain S, Self WH, Wunderink RG et al. Com­munity-acquired pneumonia requir­­ing hospitalization among U.S. adults. N Engl J Med 2015; 373(5): 415– 427. doi: 10.1056/ NEJMoa1500245.

14. Lim WS, Baudouin SV, George RC et al. BTS guide­lines for the management of com­munity acquired pneumonia in adults: update 2009. Thorax 2009; 64 (Suppl 3): 1– 55. doi: 10.1136/ thx.2009.121434.

15. Cil­lóniz C, Ewig S, Fer­rer M et al. Com­munity--acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care 2011; 15(5): R209. doi: 10.1186/ cc10444.

16. Kawai S, Ochi M, Nakagawa T et al. Antimicrobial ther­apy in com­munity-acquired pneumonia among emergency patients in a university hospital in Japan. J Infect Chemother 2004; 10(6): 352– 358. doi: 10.1007/ s10156-004-0350-2.

17. Shah BA, Singh G, Naik MA et al. Bacteriological and clinical profile of Com­munity acquired pneumonia in hospitalized patients. Lung India 2010; 27(2): 54– 57. doi: 10.4103/ 0970-2113.63606.

18. Cil­lóniz C, Dominedo C, Nicolini A et al. PES pathogens in severe com­munity-acquired pneumonia. Microorganisms 2019; 7(2): 49. doi: 10.3390/ microorganisms7020049.

19. Cil­lóniz C, Ewig S, Polverino E et al. Com­munity--acquired pneumonia in outpatients: etiology and outcomes. Eur Respir J 2010; 40(4): 931– 938.

20. Johans­son N, Kalin M, Hedlund J. Clinical impact of combined viral and bacterial infection in patients with com­munity-acquired pneumonia. Scand J Infect Dis 2011; 43(8): 609– 615. doi: 10.3109/ 00365548.2011.570785.

21. Gilbert DN. Procalcitonin as a bio­marker in respiratory tract infection. Clin Infect Dis 2011; 52 (Suppl 4): 346– 350. doi: 10.1093/ cid/ cir050.

22. Ramírez P, Fer­rer M, Martí V et al. Inflam­matory bio­markers and prediction for intensive care unit admis­sion in severe com­munity-acquired pneumonia. Crit Care Med 2011; 39(10): 2211– 2217. doi: 10.1097/ CCM.0b013e3182257445.

23. Krüger S, Ewig S, Mar­re R. Procalcitonin predicts patients at low risk of death from com­munity-acquired pneumonia across all CRB-65 clas­ses. Eur Respir J 2008; 31(2): 349– 355. doi: 10.1183/ 09031936.00054507.

24.Woodhead M, Blasi F, Ewig S et al. Guidelines for the management of adult lower respiratory tract infections –  sum­mary. Clin Microbio­l Infect 2011; 17 (Suppl 6): 1– 24. doi: 10.1111/ j.1469-0691.2011.03602.x.

25. Johans­son N, Kalin M, Tiveljung-Lindell A et al. Etiology of com­munity-acquired pneumonia: in­creased microbio­logical yield with new dia­gnostic methods. Clin Infect Dis 2010; 50(2): 202– 209. doi: 10.1086/ 648678.

26. Shibli F, Chazan B, Nitzan O et al. Etiology of com­munity-acquired pneumonia in hospitalized patients in northern Israel. Isr Med As­soc J 2010; 12(8): 477– 482.

27. Garin N, Marti C. Com­munity-acquired pneumonia: the elusive quest for the best treatment strategy. J Thorac Dis 2016; 8(7): E571– E574. doi: 10.21037/ jtd.2016.05.13.

28. Lee JS, Giesler DL, Gel­lad WF et al. Antibio­tic ther­apy for adults hospitalized with com­munity--acquired pneumonia: a systematic review. JAMA 2016; 315(6): 593– 602. doi: 10.1001/ jama.2016.0115.

29. Del­linger RP. A lifetime of critical care: changes. Crit Care Med 2016; 44(4): 653– 654. doi: 10.1097/ CCM.0000000000001734.

30. Gattarel­lo S, Lagunes L, Vidaur L et al. Improvement of antibio­tic ther­apy and ICU survival in severe non-pneumococcal com­munity-acquired pneumonia: a matched case-control study. Crit Care 2015; 19: 335. doi: 10.1186/ s13054-015-1051-1.

31. Kolek V, Kolář M, Kašák V a kol. Dia­gnostika a léčba komunitní pneumonie dospělých. In: Kolek Vet al. Doporučené postupy v pneumologii. Praha: Maxdorf 2013: 107– 123.

32. Jakubec P, Kolek V, Kolář M. Dia­gnostika a léčba těžké pneumonie. In: Kolek V a kol. Doporučené postupy v pneumologii. Praha: Maxdorf 2013: 124– 140.

33. Muthuri SG, Venkatesan S, Myles PR et al. Ef­fectiveness of neuraminidase inhibitors in reduc­­ing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med 2014; 2(5): 395– 404. doi: 10.1016/ S2213-2600(14)70041-4.

34. Frat JP, Arnaud WT, Mercat A et al. High-flow oxygen through nasal can­nula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372(23): 2185– 2196. doi: 10.1056/ NEJMoa1503326.

35. Fer­rer M, Cosentini R, Nava S. The use of non-invasive ventilation dur­­ing acute respiratory fail­ure due to pneumonia. Eur J Inter Med 2012; 23(5): 420– 428. doi: 10.1016/ j.ejim.2012.02.011.

36. Stefan MS, Priya A, Pekow PS et al. The comparative ef­fectiveness of nonivasive and invasive ventilation in patients with pneumonia. J Crit Care 2018; 43: 190– 196. doi: 10.1016/ j.jcrc.2017.05.023.

37. Wan YD, Sun TW, Liu ZQ et al. Ef­ficacy and safety of corticosteroids for com­munity-acquired pneumonia: a systematic review and meta-analysis. Chest 2016; 149(1): 209– 219. doi: 10.1378/ chest.15-1733.

38. Huang J, Guo J, Li H et al. Ef­ficacy and safety of adjunctive corticosteroids ther­apy for patients with severe com­munity-acquired pneumonia. A systematic review and meta-analysis. Medicine 2019; 98(13): e14636. doi: 10.1097/ MD.0000000000014636.

39. Cor­rales-Medina VF, Musher DM, Shachkina Set al. Acute pneumonia and the cardiovascular system. Lancet 2013; 381(9865): 496– 505. doi: 10.1016/ S0140-6736(12)61266-5.

40. Viasus D, Garcia-Vidal C, Manresa F et al. Risk stratification and prognosis of acute cardiac events in hospitalized adults with com­munity-acquired pneumonia. J Infect 2013; 66(1): 27– 33. doi: 10.1016/ j.jinf.2012.09.003.

41. Feldman C, Anderson R. Prevalence, pathogenesis, ther­apy, and prevention of cardiovascular events in patients with com­munity-acquired pneumonia. Pneumonia 2016; 8: 11. doi: 10.1186/ s41479-016-0011-0.

42. Goncalves-Pereira J, Conceicao C, Póvoa P. Com­munity-acquired pneumonia: identification and evaluation of nonresponders. Ther Adv Infect Dis 2013; 1(1): 5– 17. doi: 10.1177/ 2049936112469017.

43. Metersky ML, Waterer G, Nsa W et al. Predictors of in-hospital vs postdischarge mortality in pneumonia. Chest 2012; 142(2): 476– 481. doi: 10.1378/ chest.11-2393.

44. Restrepo MI, Mortensen EM, Rel­lo J et al. Late admis­sion to the ICU in patients with com­munity-acquired pneumonia is as­sociated with higher mortality. Chest 2010; 137(3): 552– 557. doi: 10.1378/ chest.09-1547.

45. Fine MJ, Smith MA, Carson CA et al. Prognosis and outcomes of patients with com­munity-acquired pneumonia. A meta-analysis. JAMA 1996; 275(2): 134– 141.

46. Kothe H, Bauer T, Mar­rer R et al. Outcome of com­munity-acquired pneumonia: influence of age, residence status, and antimicrobial treatment. Eur Respir J 2008; 32(1): 139– 146. doi: 10.1183/ 09031936.00092507.

47. Sligl WI, Eurich DT, Mar­rie TJ. Only severely limited, premorbid functional status is as­sociated with short- and long-term mortality in patients with pneumonia who are critical­ly il­l: a prospective observational study. Chest 2011; 139(1): 88– 94. doi: 10.1378/ chest.10-1054.

48. Lindenauer PK, Lagu T, Shieh MS et al. As­sociation of dia­gnostic cod­­ing with trends in hospitalizations and mortality of patients with pneumonia, 2003–2009. JAMA 2012; 307(13): 1405– 1413. doi: 10.1001/ jama.2012.384.

49. Nair GB, Niederman MS. Com­munity-acquired pneumonia: an unfinished battle. Med Clin North Am 2011; 95(6): 1143– 1161. doi: 10.1016/ j.mcna.2011.08.007.

50. Karhu J, Ala-Kokko TI, Ylipalosaari P et al. Hospital and long-term outcomes of ICU-treated severe com­munity- and hospital-acquired, and ventilator-as­sociated pneumonia patients. Acta Anaesthesiol Scand 2011; 55(10): 1254– 1260. doi: 10.1111/ j.1399-6576.2011.02535.x.

51. Car­ron M, Freo U, Zorzi M et al. Predictors of fail­ure of noninvasive ventilation in patients with severe com­munity-acquired pneumonia. J Crit Care 2010; 25(3): 540.e9– e14. doi: 10.1016/ j.jcrc.2010.02.012.

52. Rel­lo J. Demographics, guidelines, and clinical experience in severe com­munity-acquired pneumonia. Crit Care 2008; 12 (Suppl 6): S2. doi: 10.1186/ cc7025

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