Community-acquired pneumonia: still a major burden of disease

Describe recent studies that may impact on the management of community-acquired pneumonia (CAP).

CAP continues to be associated with a considerable burden of disease. Diagnosis remains problematic, and various biomarkers are neither accurate in the diagnosis of the presence of CAP nor superior to standard severity of illness scores in predicting outcome. Current evidence indicates that patients with nonsevere CAP can be effectively treated with antibiotic monotherapy, whereas those with severe infection, particularly ICU cases, do best with early initiation of combination antibiotic therapy. Several studies have investigated anti-inflammatory, adjunctive therapies for severe CAP, with corticosteroids appearing to be most promising. It is well recognized that cardiac complications occur during the course of CAP, being associated with poorer short-term and long-term outcomes, prompting considerable interest in the adjunctive potential of statins and antiplatelet therapies. In addition to evaluating these adjunctive therapies, attention has also focused on identifying strategies that predict the need for ICU admission in patients with CAP.

Although questions remain, particularly with regard to prediction of outcome, recent studies of CAP, both clinical and experimental, have contributed novel insights into disease pathogenesis that may enable improvement of current treatment strategies.