Severe Community Pneumonia

Infection & Sepsis · ICU Decoded chapter 35 · Free in full

Cited to ATS/IDSA CAP 2019.

Key points

Severe CAP means 1 major criterion (pressors/intubation) or ≥3 minor (CURB/SMART-COP): ICU admission plus β-lactam plus macrolide or respiratory fluoroquinolone.
Obtain blood cultures ×2 and sputum before antibiotics; check urine antigens (legionella, pneumococcus) in severe cases.
Reserve corticosteroids for severe CAP with septic shock or refractory hypoxemia, per evidence.
Switch to oral at clinical stability; the typical total course is 5–7 days.
A 2025 ATS CAP guideline update exists and IDSA withdrew endorsement — confirm the final document before citing it locally.

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