Sepsis pp 22-40 | Cite as

Community-Acquired Pneumonia (International Vision)

  • Alejandro Rodríguez
  • Jordi Rello


Community-acquired pneumonia (CAP) is generally regarded as pneumonia requiring a specific clinical approach in the intensive care unit (ICU). Between 10% and 36% of patients with CAP who are hospitalized need ICU treatment, and mortality ranges from 20% to 50%. The ICU admission and management should be customized in each patient.

The spectrum of causative agents of severe CAP (SCAP) is similar to that found in hospitalized patients or outpatients with CAP. Streptococcus pneumoniae and Legionella species (spp.) account for 50% of cases with etiologic diagnosis. However, Legionella spp. are rarely reported in South America, where S. pneumoniae, Haemophilus influenzae, and Staphylococcus aureus are the most frequent findings. Interestingly, ICU admission for tuberculosis can reach 10% of total cases in some countries.

The usefulness of diagnostic testing in the management of SCAP is a subject of controversy. However, knowledge of the causative agents is useful, given the possibility of adjusting antibiotic treatment, and improves the outcome. Blood culture, Gram stain, and urinary detection of antigens should be done.

Shock and refractory hypoxemia management do not differ for the general population with septic shock. The goal of resuscitation in shock is the restoration of tissue perfusion. Normalization of cellular metabolism and noninvasive forms of ventilation or a protective ventilatory strategy using low tidal volumes are recommended.

The guidelines for initial antibiotic management should be customized to each country or to each institution and patient. We believe that cefotaxime/ceftriaxone should be the cornerstone of therapy in combination with macrolide, but antibiotic coverage for Legionella spp. and Pseudomonas aeruginosa might be necessary in intubated critically ill patients when SCAP etiology is unknown.


Intensive Care Unit Admission Mean Arterial Pressure Respir Crit Pneumonia Severity Index International Vision 
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© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Alejandro Rodríguez
  • Jordi Rello

There are no affiliations available

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