Clinical Review State of the Art Review

Advances in the causes and management of community acquired pneumonia in adults

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j2471 (Published 10 July 2017) Cite this as: BMJ 2017;358:j2471
  1. Richard G Wunderink, professor of medicine1,
  2. Grant Waterer, professor of medicine1 2
  1. 1Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
  2. 2University of Western Australia, Perth, Australia
  1. Correspondence to: R Wunderink r-wunderink{at}northwestern.edu

Abstract

Community acquired pneumonia remains a common cause of morbidity and mortality. Usually, the causal organism is not identified and treatment remains empiric. Recent computed tomography and magnetic resonance imaging studies have challenged the accuracy of the clinical diagnosis of pneumonia, and epidemiologic studies are changing our perspective of what causes community acquired pneumonia, especially the role of viral pathogens and the frequent finding of multiple pathogens. The past decade has seen increasing overuse of empiric coverage of meticillin resistant Staphylococcus aureus and antibiotic resistant Gram negative pathogens owing to inappropriate application of guidelines for healthcare associated pneumonia. Optimal treatment remains a matter for debate, especially in very sick patients, including the role of combination antibiotic therapy and corticosteroids. Pneumonia care bundles are being defined to improve outcomes. Increased recognition of both acute and long term cardiac complications is shifting our concept of pneumonia from an acute lung disease to a multisystem problem with adverse chronic health consequences.

Footnotes

  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: Both authors contributed equally and fully in all aspects of this manuscript.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: RGW’s institution received an investigator initiated grant from bioMerieux.

  • Provenance and peer review: Commissioned; externally peer reviewed.

  • No patients were asked for input in the creation of this article.

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