Sepsis and community-acquired pneumonia

Community-acquired pneumonia (CAP) is a common disease and a leading cause of death. CAP may cause local and systemic inflammation, leading to a dysregulated host response and eventually to sepsis, multi-organ dysfunction, septic shock and death. Therefore, early diagnosis and assessment of the risk of poor outcomes is mandatory. Recent studies suggest that the scores developed for CAP predict the risk of death better than Sequential (Sepsis-related) Organ Failure Assessment (SOFA) or qSOFA and that early diagnosis can allow adequate management of patients with sepsis. Fluid resuscitation should be started with a target of a median arterial pressure of 65 mmHg and normalization of serum lactate values, following a hemodynamic assessment to avoid excessive fluid administration. Antibiotics should be administered within the first hour; if the patient has no risk factors for multidrug-resistant organisms, we suggest a third generation cephalosporin combined with a macrolide.