Challenges in severe community-acquired pneumonia: a point-of-view review

Abstract

Purpose: Severe community-acquired pneumonia (SCAP) is still associated with substantial morbidity and mortality. In this point-of-view review paper, a group of experts discuss the main controversies in SCAP: the role of severity scores to guide patient settings of care and empiric antibiotic therapy; the emergence of pathogens outside the core microorganisms of CAP; viral SCAP; the best empirical treatment; septic shock as the most lethal complication; and the need for new antibiotics. Methods: For all topics, the authors describe current controversies and evidence and provide recommendations and suggestions for future research. Evidence was based on meta-analyses, most recent RCTs and recent interventional or observational studies. Recommendations were reached by consensus of all the authors. Results and conclusions: The IDSA/ATS criteria remain the most pragmatic tool to predict ICU admission. The authors recommend a combination of a beta-lactam/beta-lactamase inhibitor or a third G cephalosporin plus a macrolide in most SCAP patients, and to empirically cover PES (P. aeruginosa, extended spectrum beta-lactamase producing Enterobacteriaceae, methicillin-resistant S. aureus) pathogens when at least two specific risk factors are present. In patients with influenza CAP, the authors recommend the use of oseltamivir and avoidance of the use of steroids. Corticosteroids can be used in case of refractory shock and high systemic inflammatory response.

Severe flu management: a point of view

“…From the practical point of view, in patients with severe influenza our advice is to add antimicrobial agents, such as a combination of a third-generation cephalosporin (ceftriaxone) plus a macrolides. A more advanced generation cephalosporin such as ceftaroline may be more suitable, since it covers S. pneumoniae, S. aureus, and non-extended-spectrum β-lactamase (ESBL) Enterobacteriaceae [59]. In case of risk factors for Pseudomonas spp.…”

Staphylococcus aureus Pneumonia in the Community

“…45 An international survey showed that three risk factors were independently associated with MRSA pneumonia: previous MRSA infection or colonization, recurrent skin infections, and severe pneumonia. 46,50 No clear risk factors are linked to CA-MRSA. 51,52 Outbreaks have been reported among persons who have close contact, especially with skin trauma (e.g., athletes), 53 and people living in closed communities (e.g., maternity wards, military establishments, day-care facilities, and prisons).…”

Critical Parameters for the Development of Novel Therapies for Severe and Resistant Infections—A Case Study on CAL02, a Non-Traditional Broad-Spectrum Anti-Virulence Drug

“…That being said, recent trials in severe pneumonia underscore that, in the majority of the cases, patients who are considered "cured" continue to suffer from acute and long-term complications. These complications are responsible for the economic burden of the disease and for much of the mortality [18][19][20][32][33][34]. Bacteria have triggered pathogenic processes against which antibiotics, themselves, are powerless.…”