Has mortality of community-acquired pneumonia really reduced?

Community-acquired pneumonia is a major health problem associated with high morbidity and mortality, and hospital admissions for pneumonia seem to be increasing. Whether mortality is currently decreasing is controversial and is influenced by several factors: aging population and increase in comorbidities, microbiological and antibiotic changes, management improvements in intensive care units, pneumococcal and influenza vaccines, and immunomodulatory treatments. Despite the heterogeneity of data, in the last few years, some important articles have been published, suggesting a progressive decline in mortality despite an upward trend in patient age and comorbidities. However, increasing efforts are needed for a more significant improvement in the prognosis of these patients. For example, enhanced adherence to guidelines and a more rigorous sepsis management, as well as improvement in vaccine results are required. Moreover, new and improved diagnostic tests and antibiotic regimens will probably be required, just like better identification of patients who may benefit from immunomodulatory therapy.