Antimicrobial Management of Severe Chlamydia psittaci Pneumonia in Adults: A Narrative Review
Abstract
Abstract: Chlamydia psittaci is an obligate intracellular bacterium and an increasingly recognized cause of severe community-acquired pneumonia (CAP) in adults, with contemporary multicenter Chinese cohorts reporting severe-stratum in-hospital mortality clustering around 8– 9% and higher figures in acute respiratory distress syndrome (ARDS)-enriched series. β-Lactam therapy lacks reliable activity against this pathogen, yet considerable practice variation persists in the selection, sequencing, and de-escalation of intracellularly active agents in the era of routine metagenomic and targeted next-generation sequencing (mNGS, tNGS). The aim of this review is to provide a phase- and severity-stratified, bedside antimicrobial framework for severe psittacosis in adults—clarifying when to select, continue, switch, or combine intracellularly active agents at the 48- to 72-hour ICU decision points. This narrative review, reported in accordance with the SANRA framework, synthesizes the post-2015 antimicrobial evidence for severe C. psittaci pneumonia in adults and integrates treatment phase (empirical versus targeted), severity context, organ support, and antimicrobial stewardship at the 48- to 72-hour ICU decision points. Drawing on six multicenter cohorts and the largest dedicated multicenter dataset to date (Fang 2026, n = 186; severe-stratum mortality 7/81 = 8.6%), phase-by-severity stratification reconciles apparently discordant tetracycline- and fluoroquinolone-favoring cohort…
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