Community-acquired pneumonia (CAP) is a prevalent health concern, leading to hospitalizations in approximately 2% of adults aged 65 and older. Among those hospitalized, the 30-day mortality rate is significant, reported at around 6%. Pre-pandemic studies indicated that bacterial pathogens were identified in 11% of CAP cases, viral pathogens in 23%, while no organism was identified in a substantial 62% of patients. Recognizing specific signs and symptoms plays a crucial role in the initial diagnosis of community-acquired pneumonia and guides the selection of appropriate imaging techniques.
Diagnostic Approaches for Community-Acquired Pneumonia
Diagnosis of CAP typically involves a comprehensive approach, integrating patient history, thorough physical examinations, and findings from chest radiography, lung ultrasonography, or computed tomography (CT) scans. It’s important to note that procalcitonin measurement is not currently recommended as a routine diagnostic tool for CAP.
Risk Stratification Using CRB-65
For risk stratification in primary care settings, the CRB-65 tool is a well-validated and practical method. This tool assesses key indicators—Confusion, Respiratory rate, Blood pressure, and age ≥65 years—and importantly, it does not necessitate laboratory testing, making it readily applicable in various clinical environments.
Treatment Strategies for Community-Acquired Pneumonia
Outpatient Management
For outpatients diagnosed with community-acquired pneumonia who do not present with comorbidities, recommended treatment options include amoxicillin, doxycycline, or a macrolide. However, it’s crucial to consider local resistance patterns when prescribing macrolides, as they are only advised in regions where pneumococcal resistance to macrolides is below 25%.
Inpatient and Comorbid Outpatient Management
In cases of outpatients with comorbidities and inpatients suffering from nonsevere pneumonia, treatment guidelines suggest a combination therapy. This often involves a beta-lactam or a third-generation cephalosporin in conjunction with a macrolide. Alternatively, monotherapy with a respiratory fluoroquinolone is also considered an effective approach in these patient populations.
Special Considerations for Specific Pathogens
Treatment strategies should be adapted based on the risk of specific pathogens. Targeted therapy for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas infection is recommended only when patients exhibit specific risk factors for these particular pathogens. Routine broad-spectrum antibiotic use without identified risk factors is generally discouraged to prevent antibiotic resistance.
Vaccination Recommendations for Prevention
Vaccination plays a pivotal role in preventing community-acquired pneumonia, particularly in vulnerable populations. All adults aged 65 years or older, as well as younger adults between 19 and 64 years with underlying health conditions, should receive pneumococcal vaccination. Current guidelines recommend either the 20-valent pneumococcal conjugate vaccine alone or a sequential approach using the 15-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine one year later. It is important to note that the 13-valent pneumococcal conjugate vaccine is no longer recommended for routine administration in adults.
Furthermore, public health organizations, such as the Centers for Disease Control and Prevention (CDC), universally recommend influenza and SARS-CoV-2 vaccination for all adults to mitigate the risk of pneumonia and related complications from these viral infections.
