Managing CAP in the ICU.

Despite remarkable progress in diagnosis and antibiotic therapy, mortality due to pneumonia has not changed significantly and ICU admissions are increasing. The management includes early evaluation of severity, collection of microbiological cultures, and appropriate antibiotic administration. The prognostic scores as the ATS/IDSA rule, the PIRO, or SCAP system are valuable in timely recognition of critically ill patients with community-acquired pneumonia (CAP) requiring admission to ICU. Implementation of guidelines for CAP treatment should be emphasized in order to increase survival. Guidelines for antibiotic management for severe CAP are based on illness severity, covering most likely bacterial and atypical pathogens and the level of ICU antibiotic resistance. Combination therapy suggested in patients with nonrefractory septic shock and severe sepsis pneumococcal bacteremia also. Recent studies suggest that steroid therapy may be valuable in nonrefractory septic shock from sCAP.