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Severe community-acquired pneumonia: optimal management

Leoni, Davide; Rello, Jordi

Current Opinion in Infectious Diseases: April 2017 - Volume 30 - Issue 2 - p 240–247
doi: 10.1097/QCO.0000000000000349
RESPIRATORY INFECTIONS: Edited by Michael S. Niederman
Editor's Choice

Purpose of review: Community-acquired pneumonia (CAP) is the leading cause of mortality among infectious diseases. Several efforts have been implemented to achieve better outcomes, but an important proportion of patients continue dying. This review focuses on the newest research on prognostic factors and diagnostics, opening new perspectives in the management of CAP.

Recent findings: CAP survival improved in recent years despite an increasing incidence of severe presentations. Appropriateness of antimicrobial choice, combination therapy and early administration of antibiotics has proved to be decisive. Novel biomarkers, as monocyte human leukocyte antigen-DR, presepsin and proadrenomedullin, have been explored for the prediction of severe CAP; moreover, the application of new techniques in metabolomics, genomics and microbiomics in the field of infections may contribute to predicting clinical instability and worse outcomes, showing that precise individual phenotypes are key factors for survival. CAP with unidentified organism is still an issue of concern, but new rapid molecular tests improve yield rates, revealing an unexpected high prevalence of viral detection and proving their usefulness also in the recognition of bacterial causes.

Summary: Precision medicine applied to risk stratification and diagnosis, together with rapid microbiologic molecular testing, may contribute to optimizing the management of CAP, with potential additional reduction of mortality rates.

aInfectious Disease Department, Tor Vergata University Hospital, University of ‘La Sapienza’, Rome, Italy

bClinical Research & Innovation in Pneumonia & Sepsis (CRIPS)

cCentro de Investigación Biomédica En Red – Enfermedades Respiratorias (CIBERES), Vall d’Hebron Institute of Research

dUniversitat Autònoma de Barcelona, Barcelona, Spain

Correspondence to Davide Leoni, MD, Tor Vergata University Hospital, Infectious Disease Unit, Viale Oxford 81, 00133 Rome, Italy; Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS), Pg Vall d’Hebron 119, AMI-14°, Planta, 08035 Barcelona, Spain. Tel: +39 3345308556; e-mail: davideleoni.tre@gmail.com

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