CE: Alpana; MCC/240609; Total nos of Pages: 10; MCC 240609 C URRENT O PINION Community-acquired pneumonia as an emergency condition Catia Cillo´niz a AQ2 , Cristina Dominedo ` b , Carolina Garcia-Vidal c , and Antoni Torres a Purpose of review Despite the improvements in its management, community-acquired pneumonia (CAP) still exhibits high global morbidity and mortality rates, especially in elderly patients. This review focuses on the most recent findings on the epidemiology, cause, diagnosis and management of CAP. Recent findings There is consistent evidence that the trend in CAP mortality has declined over time. However, the mortality of pneumococcal CAP has not changed in the last two decades, with an increase in the rate of hospitalization and more severe forms of CAP. Streptococcus pneumoniae remains the most frequent cause of CAP in all settings, age groups and regardless of comorbidities. However, the implementation of molecular diagnostic tests in the last years has identified respiratory viruses as a common cause of CAP too. The emergency of multidrug-resistance pathogens is a worldwide concern. An improvement in our ability to promptly identify the causative cause of CAP is required in order to provide pathogen-directed antibiotic therapy, improve antibiotic stewardship programs and implement appropriate vaccine strategies. Summary It is time to apply all the knowledge generated in the last decade in order to optimize the management of CAP. Keywords community-acquired pneumonia, epidemiology, management, microbial cause INTRODUCTION AQ4 Community-acquired pneumonia (CAP) is an emer- gency condition with high morbidity and mortality [1–3]. The incidence of CAP continues to rise, espe- cially among elderly and immunocompromised patients [3,4]. Pneumonia is the most common infection leading to sepsis [5,6]. A recent study reported the association of four comorbidities (dia- betes mellitus, dementia, chronic heart failure and coronary heart disease) on the development of sep- sis in CAP patients [7]. Approximately 65% of elderly patients hospitalized with CAP have two or more comorbidities, thus experiencing a higher risk of being affected by sepsis [4,8]. Severe CAP is frequently complicated by pulmo- nary and extra-pulmonary complications, including sepsis, septic shock, acute respiratory distress syn- drome and acute cardiac events, thus resulting in a significant increase of mortality and need for ICU admission [4,9–13]. Although there is no general consensus on its definition, the most accepted cri- teria to address severe CAP are based on the 2007 Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the man- agement of CAP in adults [1]. Severe CAP is defined by the presence of two major criteria: severe acute respiratory failure requiring invasive mechanical ventilation and/or septic shock. Several minor crite- ria requiring high-intensity monitoring and treat- ment have been proposed for severe CAP diagnosis too [14]. a Department of Pneumology, Hospital Clinic of Barcelona, Institut d’Investigacions Biome ` diques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Barcelona, Spain, b Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Universita ` Cattolica del Sacro Cuore, Rome, Italy and c Infec- Infectious Disease Department, Hospital Clinic of Barcelona, Barcelona, AQ3 Spain Correspondence to Antoni Torres, Department of Pulmonary Medicine, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain. Tel: +34 93 227 5779; fax: +34 93 227 9813; e-mail: atorres@clinic.cat Curr Opin Crit Care 2018, 24:000–000 DOI:10.1097/MCC.0000000000000550 1070-5295 Copyright ß 2018 Wolters Kluwer Health, Inc. All rights reserved. www.co-criticalcare.com REVIEW