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Community-Acquired Pneumonia: A Review.

Valerie M Vaughn1,2,3, Robert P Dickson4,5,6, Jennifer K Horowitz3

  • 1Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.

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Community-acquired pneumonia (CAP) is a serious infection affecting millions annually. Prompt diagnosis and appropriate antibiotic therapy, such as ceftriaxone and azithromycin, are crucial for effective treatment and improved patient outcomes.

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Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Community-acquired pneumonia (CAP) is a significant public health concern in the US, leading to millions of emergency visits, hospitalizations, and deaths annually.
  • Older adults and individuals with compromised immune systems or underlying lung conditions face a higher risk of CAP and its severe complications, including sepsis and acute respiratory distress syndrome.

Purpose of the Study:

  • To outline the diagnostic criteria for Community-acquired pneumonia (CAP).
  • To discuss the recommended empirical treatment strategies for CAP based on disease severity and potential pathogen resistance.
  • To highlight the importance of testing for common viral pathogens like influenza and COVID-19.

Main Methods:

  • Diagnosis of CAP is based on clinical signs, symptoms, and radiographic evidence of pneumonia without an alternative explanation.
  • Pathogen identification in hospitalized CAP patients is achieved in only 38% of cases, with viruses and Streptococcus pneumoniae being common culprits.
  • Empirical treatment decisions consider disease severity, likelihood of bacterial or resistant infections, and potential harms of antibiotic overuse.

Main Results:

  • Hospitalized patients with suspected bacterial CAP and no risk factors for resistant bacteria can be treated with a β-lactam/macrolide combination for at least 3 days.
  • Testing for COVID-19 and influenza is recommended for all CAP patients during periods of high community prevalence.
  • Systemic corticosteroids may reduce 28-day mortality in severe CAP cases when administered within 24 hours of symptom onset.

Conclusions:

  • Community-acquired pneumonia (CAP) requires prompt diagnosis and management, with treatment tailored to disease severity and suspected etiology.
  • Empirical antibiotic therapy, such as ceftriaxone and azithromycin, is a common approach for hospitalized patients without risk factors for resistant pathogens.
  • Early administration of corticosteroids may improve outcomes in severe CAP.