ABSTRACT
Treatment failure is a matter of great concern in the management of community-acquired
pneumonia (CAP). Defined generally as lack of response or clinical deterioration,
failure is considered early when it occurs within the first 72 hours and late when
it occurs after 72 hours. The reported incidence of treatment failure among hospitalized
patients with CAP ranges from 2.4 to 31% for early failure and from 3.9 to 11% for
late failure. Most cases of early failure occur because of inadequate host–pathogen
responses. Factors associated with treatment failure include high-risk pneumonia,
liver disease, multilobar infiltrates, Legionella pneumonia, gram-negative pneumonia, pleural effusion, cavitation, leucopenia, and
discordant antimicrobial therapy. Conversely, influenza vaccination, initial treatment
with fluoroquinolones, and chronic obstructive pulmonary disease have been linked
with a lower risk of failure. Treatment failure is associated with high morbidity
and mortality rates. Its detection and management require careful clinical assessment.
Certain serum biological markers may be helpful to identify patients with a higher
risk of deterioration and poor prognosis. Because inadequate host–pathogen responses
are responsible for a significant number of failures, strategies aimed at modulating
the inflammatory response should be investigated. Discordant therapy can be prevented
by rational application of the current antibiotic guidelines.
KEYWORDS
Early failure - late failure - community-acquired pneumonia - inflammatory response
- biomarkers
REFERENCES
Legionella pneumonia in the antigenuria era: the influence of levofloxacin therapy.
Clin Infect Dis.
2005;
40
794-799
jcarratala@ub.edu
