Community-Acquired Pneumonia

• Community-acquired pneumonia (CAP) is the most common cause of admission of adults in the USA. • Diagnosis of community-acquired pneumonia is relatively easy in previously healthy patients but may be challenging in those with underlying cardiopulmonary disease or in the elderly. • The highest yield for diagnostic testing for CAP etiology is in the critically ill and those with risk factors for drug-resistant pathogens. • The majority of hospitalized CAP patients can be treated with either a respiratory fluoroquinolone or cephalosporin/macrolide combination. • Alternative antibiotic treatment should be based on presence of multiple risk factors for drug-resistant pathogens (i.e. healthcare-associated pneumonia), specific risks (e.g. travel or zoonotic risks), or unique syndromes (e.g. toxin-mediated community-acquired MRSA syndrome). • Decisions regarding initial placement in an intensive care unit (ICU) of tenuous CAP patients should be based on the number of minor physiologic factors and laboratory abnormalities associated with risk of subsequent deterioration. • Number of deaths by pneumonia is decreasing in the world linked to child vaccination of pneumococcus and large-scale use of antibiotics in India/China.