Community-acquired pneumonia in casualty: Etiology, clinical features, diagnosis, and management (or a look at the "new" in pneumonia since 2002)

Purpose of review: Community-acquired pneumonia, because of its substantial treatment costs, incidence, and mortality, is an aggressively researched diagnosis. In this review, we highlight new developments in the diagnosis, etiology, pathophysiology, treatment, and prevention of community-acquired pneumonia published since April 2002. Recent findings: The combined end points of improved patient care and conservation of health care resources have prompted several studies examining current professional society community-acquired pneumonia guidelines. In general, patients treated with the recommended third-generation cephalosporin and macrolide or an antipneumococcal fluoroquinolone when indicated have fared better, including reduced overall costs, inpatient days, and mortality, than those receiving alternative treatments. Etiologic identification efforts by traditional methods, blood and sputum cultures, are being questioned owing to poor success rates and, even when positive, are being underused or ignored in antibiotic selection and patient management. Newer diagnostic tests are becoming commercially available, along with tests for biologic markers that have been only recently identified as contributors to, or prognosticators of, community-acquired pneumonia. Because antibiotic resistance remains a major obstacle to successful patient treatment, prevention or mitigation of community-acquired pneumonia is gaining increasing popularity through more aggressive pneumococcal and influenza vaccination of at risk groups, even before hospital discharge from a community-acquired pneumonia admission. Summary: Although prevention is our best defense, current community-acquired pneumonia treatment guidelines are effective for treatment and cost containment. However, they should be scrutinized in light of clinical utilization data now entering the literature regarding their testing recommendations. Providers should consider encouraging focused culturing of sicker patients and those with significant comorbidities.