Interventions to improve outcomes in community-acquired pneumonia

ABSTRACT

Introduction

Community-acquired pneumonia (CAP) is a common infection associated with high morbimortality and a highly deleterious impact on patients’ quality of life and functionality. We comprehensively review the factors related to the host, the causative microorganism, the therapeutic approach and the organization of health systems (e.g. setting for care and systems for allocation) that might have an impact on CAP-associated outcomes. Our main aims are to discuss the most controversial points and to provide some recommendations that may guide further research and the management of patients with CAP, in order to improve their outcomes, beyond mortality.

Area covered

In this review, we aim to provide a critical account of potential measures to improve outcomes of CAP and the supporting evidence from observational studies and clinical trials.

Expert opinion

CAP is associated with high mortality and a highly deleterious impact on patients’ quality of life. To improve CAP-associated outcomes, it is important to understand the factors related to the patient, etiology, therapeutics, and the organization of health systems.

KEYWORDS:

• Pneumonia
• community-acquired pneumonia
• outcomes
• severe pneumonia
• respiratory infection

Acknowledgement

We want to express our appreciation to Dr. James D. Chalmers, Dr. Charles Dela Cruz, Dr. Kristina Crothers and Dr. Marcos Restrepo for their support and advice.

Article highlights

• Community-acquired pneumonia is associated with high mortality and strongly deleterious impacts on patients’ quality of life and functionality.

• There has been a change in the epidemiological profile of CAP over the last decade at the global level. An increase in the number of immunocompromised and elderly patients with pneumonia was reported, and the management of these populations required tailored approaches, which are distinct from those required for the management of CAP in the general population

• Respiratory viruses and difficult-to-treat pathogens have become an important cause of CAP, posing a challenge for the microbiological diagnosis of pneumonia.

• To improve CAP-associated outcomes, it is important to integrate patient-related factors, microbial etiology, therapeutics, and the organization of health systems in both the management of patients on a case-by-case basis and to design healthcare pathways.

• Interventions supported by moderate or strong evidence aimed at improving CAP outcomes include risk assessment and determining site of care, early and appropriate antimicrobial therapy, accurate and rapid pathogen identification, and adherence to treatment guidelines.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.