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New concepts in the management of CAP: a focus on severe illness - treatment and therapies

Part 1 of 2
Published on May 31, 2022   28 min

A selection of talks on Clinical Practice

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0:00
Hello. My name is Dr. Michael Niederman. I am currently a professor of clinical medicine at Weill Cornell Medical College, and I work in the Pulmonary and Critical Care Medicine Division at New York Presbyterian Weill Cornell Medical Center. I'm very happy to be with you today to discuss an important topic, namely that of new concepts in the management of community-acquired pneumonia (CAP). I'll be focusing specifically on severe illness.
0:27
I've listed here my financial disclosures, which include my consulting arrangements with a number of pharmaceutical companies and research grants. These are disclosures that would be potentially relevant to the presentation today.
0:42
I'd like to review the aims and objectives of our presentation. We will review the criteria for severe community-acquired pneumonia, we will define the bacteriology of community-acquired pneumonia, focusing again specifically on severe CAP. We'll examine the new versus the older CAP guidelines. We'll examine the efficacy of specific therapies for severe CAP. We'll compare macrolides versus quinolones as part of a combination therapy with β-lactams, and we'll define the role of steroids and other adjunctive therapies. We'll discuss when to treat for multi-drug resistant (MDR) pathogens, and we'll identify new therapies for severe MDR pathogen CAP.
1:24
Let me start by reviewing some epidemiologic data about community-acquired pneumonia in European ICUs. This study, which is now almost a decade old, looked at over 1100 patients with community-acquired pneumonia in 17 ICUs in the GenOSept study. The 28-day mortality was reported at 17%, and the mortality at six months was higher at 27%. This escalation, if you will, in mortality at six months, is very common in community-acquired pneumonia and points out that community-acquired pneumonia is really part of a systemic process where the implications and consequences continue long after the patient leaves the hospital. In this study, Streptococcus pneumonia or pneumococcus was the most common pathogen occurring in nearly 30%, but more than 30% were of an unknown etiology, and about 7% were due to inherit gram-negative bacteria. Septic shock was a univariate, but not a multivariate predictor of mortality.
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New concepts in the management of CAP: a focus on severe illness - treatment and therapies

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