Severe community-acquired pneumonia

Severe community-acquired pneumonia (sCAP) is the most frequent infectious cause of admission to the ICU and is associated with a high mortality rate that can reach 30–50%. Severity assessment is a main point of sCAP management to ensure the appropriate site of care and antibiotic therapy. The microbial aetiology of sCAP has changed over time; Streptococcus pneumoniae (pneumococcus) is the most frequent pathogen, and the proportion of sCAP caused by respiratory viruses and with a polymicrobial aetiology has increased, mainly due to better detection with new molecular techniques. Antibiotic therapy is a key factor in the management of sCAP, and several studies have shown that early empirical antibiotic administration improves patient outcomes. In general, the management of sCAP includes microbiological diagnosis, severity assessment and early empirical antibiotic treatment. The main challenge is the high prevalence of multidrug-resistant pathogens worldwide. This chapter focuses on the current state of knowledge on the management of sCAP.