[Annual review of community-acquired pneumonia (CAP) 2025]

Community-acquired pneumonia (CAP) remains a significant global health challenge. This review summarizes the major advances in clinical research or CAP between October 1, 2024, and September 30, 2025. Given the high prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) in China, PCR test for MRMP was recommended in pediatric patients to guide appropriate antibiotic selection. Increased attention is warranted for respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) due to their increasing prevalence and poor prognosis. PSI and CURB-65 scores remain the reliable tools for assessing the severity of CAP, while the SOFA-2 score may offer a promising approach for identifying patients requiring intensive care unit (ICU) admission. Although multiplex PCR (mPCR), targeted next-generation sequencing (tNGS), and metagenomic next-generation sequencing (mNGS) have been widely adopted in clinical practice, current evidence does not demonstrate sufficient benefits in improving patient survival or optimizing antibiotic stewardship. A rational, empirical antibiotic strategy should be individualized according to local pathogen epidemiology, risk of antimicrobial resistance and aspiration, and patient's clinical presentation. Short-course antibiotic therapy guided by "clinical stability" criteria is reliable, yet achieving stability requires more time in elderly patients and cases with comorbidities. Cefpirome and lefamulin are new antimicrobial agents on the market, but further clinical data are needed to support their use in severe cases and elderly patients. Suraxavir marboxil (GP681), a newly antiviral agent drug targeting the polymerase acidic protein of the influenza virus RNA polymerase, has recently been approved in China. Extending the administration of steroids to severe CAP without septic shock should be approached with extreme caution. High level of C-reactive protein may serve as a potential indicator for identifying cases who could benefit from steroids. In addition, RSV vaccines and monoclonal antibodies will emerge as important strategies for preventing RSV pneumonia in high-risk populations.