title: Community-acquired pneumonia: identification and evaluation of nonresponders.
abstract: Community acquired pneumonia (CAP) is a relevant public health problem, constituting an important cause of morbidity and mortality. It accounts for a significant number of adult hospital admissions and a large number of those patients ultimately die, especially the population who needed mechanical ventilation or vasopressor support. Thus, early identification of CAP patients and its rapid and appropriate treatment are important features with impact on hospital resource consumption and overall mortality. Although CAP diagnosis may sometimes be straightforward, the diagnostic criteria commonly used are highly sensitive but largely unspecific. Biomarkers and microbiological documentation may be useful but have important limitations. Evaluation of clinical response is also critical especially to identify patients who fail to respond to initial treatment since these patients have a high risk of in-hospital death. However, the criteria of definition of non-response in CAP are largely empirical and frequently markedly diverse between different studies. In this review, we aim to identify criteria defining nonresponse in CAP and the pitfalls associated with this diagnosis. We also aim to overview the main causes of treatment failure especially in severe CAP and the possible strategies to identify and reassess non-responders trying to change the dismal prognosis associated with this condition.
authors.affiliation: Unidade de Cuidados Intensivos Polivalente, Hospital de Sao Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Gonçalves-Pereira
authors.affiliation: Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Conceição
authors.affiliation: Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, Lisbon and CEDOC, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Póvoa
keywords: antibiotic failure; community-acquired pneumonia; intensive care; nonresponders; reassessment