Challenges in severe community-acquired pneumonia: a point-of-view review

Antoni Torres (Lead / Corresponding author), James D. Chalmers, Charles S. Dela Cruz, Cristina Dominedò, Marin Kollef, Ignacio Martin-Loeches, Michael Niederman, Richard G. Wunderink

Research output: Contribution to journalReview articlepeer-review

97 Citations (Scopus)


Purpose: Severe community-acquired pneumonia (SCAP) is still associated with substantial morbidity and mortality. In this point-of-view review paper, a group of experts discuss the main controversies in SCAP: the role of severity scores to guide patient settings of care and empiric antibiotic therapy; the emergence of pathogens outside the core microorganisms of CAP; viral SCAP; the best empirical treatment; septic shock as the most lethal complication; and the need for new antibiotics.

Methods: For all topics, the authors describe current controversies and evidence and provide recommendations and suggestions for future research. Evidence was based on meta-analyses, most recent RCTs and recent interventional or observational studies. Recommendations were reached by consensus of all the authors.

Results and Conclusions: The IDSA/ATS criteria remain the most pragmatic tool to predict ICU admission. The authors recommend a combination of a beta-lactam/beta-lactamase inhibitor or a third G cephalosporin plus a macrolide in most SCAP patients, and to empirically cover PES (P. aeruginosa, extended spectrum beta-lactamase producing Enterobacteriaceae, methicillin-resistant S. aureus) pathogens when at least two specific risk factors are present. In patients with influenza CAP, the authors recommend the use of oseltamivir and avoidance of the use of steroids. Corticosteroids can be used in case of refractory shock and high systemic inflammatory response.

Original languageEnglish
Pages (from-to)159-171
Number of pages13
JournalIntensive Care Medicine
Issue number2
Early online date31 Jan 2019
Publication statusPublished - Feb 2019


  • Antibiotics
  • Multidrug resistance
  • Scoring systems
  • Septic shock
  • Severe community-acquired pneumonia
  • Viral pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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