Purpose of review To describe the current understanding and clinical applicability of severity scoring systems in pneumonia management. Recent findings Severity scores in community-acquired pneumonia are strong markers of mortality, but are not necessarily clinical decision-aid tools. The use of severity scores to support outpatient care in low-risk patients has moderate-to-strong evidence available in the literature, mainly for the pneumonia severity index, and must be applied together with clinical judgment. It is not clear that severity scores are helpful to guide empiric antibiotic treatment. The inclusion of biomarkers and performance status might improve the predictive performance of the well known severity scores in community-acquired pneumonia. We should improve our methods for score evaluation and move toward the development of decision-aid tools. Summary The application of the available evidence favors the use of severity scoring systems to improve the delivery of care for pneumonia patients. The incorporation of new methodologies and the formulation of different questions other than mortality prediction might help the further development of severity scoring systems, and enhance their support to the clinical decision-making process for the pneumonia-management cascade.

Purpose of review The manuscript reviews the recent literature describing the occurrence, risk factors, recognition and treatment of sepsis, respiratory failure, and multiple organ dysfunction in patients with community-acquired pneumonia (CAP). Recent findings CAP may present with varying degrees of disease severity ranging from an almost asymptomatic infection to a fulminant systemic disease with both respiratory failure and multiple organ dysfunction. Severe sepsis occurs early in the course of the infection in more than 30% of cases. It may involve several organ systems and is associated with the severity and mortality of CAP. A number of factors exist, which may promote the transition of CAP from a local to a systemic disease, particularly immunosuppression and poorly controlled inflammatory responses, which promote extrapulmonary dissemination of the causative pathogens. Although CAP may be associated with complications involving most organ systems, much recent research has focused attention on cardiac complications, particularly those associated with pneumococcal infections. Biomarkers as a strategy for discriminating between invasive and noninvasive CAP have been comprehensively studied. A number of treatment strategies using antibiotics and various adjunctive therapies have been studied in severe CAP. Summary Recent research highlights the fact that CAP is frequently a systemic illness.