an integral approach
Abstract
Background: Severe community-acquired pneumonia represents the most critical manifestation of pneumonia acquired outside the hospital and remains a major cause of intensive care admission and death worldwide. It is frequently complicated by acute respiratory failure, circulatory shock, and multiple organ dysfunction, with mortality commonly exceeding 25–40%. Despite progress in vaccination programmes, microbiological diagnostics, and critical care support, major uncertainties persist regarding early recognition, pathogen identification, antimicrobial selection and duration, management of co-infections, and assessment of treatment response. These challenges are amplified by increasing host heterogeneity and antimicrobial resistance. Main body: Contemporary epidemiological studies consistently demonstrate that mortality in severe community–acquired pneumonia is closely linked to the severity of organ dysfunction rather than to pulmonary involvement alone. In response, the recent international guideline definitions incorporate both respiratory and systemic criteria to standardise identification and guide early triage. However, these frameworks also reveal substantial variability related to host factors that influence clinical presentation, microbiological findings, and outcomes. Advanced age, sex, chronic cardiopulmonary disease, diabetes, frailty, and prior healthcare exposure modify risk, while immunocompromised populations—including transplant recipients, patients with…
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