Community-Acquired Pneumonia

This Clinical Practice review presents a comprehensive evaluation and treatment approach to community-acquired pneumonia (CAP), beginning with a case vignette of a 66-year-old man with COPD presenting with fever, purulent cough, and confusion. Diagnosis is made by symptom profile plus a new infiltrate on imaging, and severity stratification utilizes ATS/IDSA criteria and CURB-65/PSI scoring systems. Key points include:

Most outpatients can be managed empirically without bacterial testing, though SARS-CoV-2 and influenza testing is advised.

Hospitalized patients require microbiologic testing (including Gram stain, cultures, urine antigens, molecular panels).

Empiric therapy is stratified based on risk for MRSA and Pseudomonas and disease severity.

De-escalation of therapy is appropriate with viral-only diagnosis or negative MRSA nasal swab.

Minimum antibiotic duration: 5 days once clinically stable.

Post-discharge mortality and cardiovascular risk are substantial, with long-term sequelae recognized.

This Clinical Practice review presents a comprehensive evaluation and treatment approach to community-acquired pneumonia (CAP), beginning with a case vignette of a 66-year-old man with COPD presenting with fever, purulent cough, and confusion. Diagnosis is made by symptom profile plus a new infiltrate on imaging, and severity stratification utilizes ATS/IDSA criteria and CURB-65/PSI scoring systems. Key points include:

Most outpatients can be managed empirically without bacterial testing, though SARS-CoV-2 and influenza testing is advised.

Hospitalized patients require microbiologic testing (including Gram stain, cultures, urine antigens, molecular panels).

Empiric therapy is stratified based on risk for MRSA and Pseudomonas and disease severity.

De-escalation of therapy is appropriate with viral-only diagnosis or negative MRSA nasal swab.

Minimum antibiotic duration: 5 days once clinically stable.

Post-discharge mortality and cardiovascular risk are substantial, with long-term sequelae recognized.