In this episode of Hospital Medicine Unplugged, we explore the evolving science and clinical realities of community-acquired pneumonia (CAP) in hospitalized adults. Drawing from leading journals such as The New England Journal of Medicine and JAMA, we walk through practical approaches every hospitalist needs when managing pneumonia on the wards.
We start with diagnosis: recognizing new infiltrates on chest imaging in the right clinical context, and how severity scoring tools like the Pneumonia Severity Index (PSI) or ATS/IDSA criteria should guide triage—but always supplemented with bedside judgment.
Next, we dive into treatment strategies:
When to use a β-lactam plus macrolide combination versus fluoroquinolone monotherapy.
How to broaden empiric coverage for MRSA and Pseudomonas in high-risk patients.
Evidence behind macrolides’ potential immunomodulatory effects in severe CAP.
Why vancomycin + piperacillin/tazobactam should be used cautiously given nephrotoxicity risks.
We also highlight microbiology and diagnostics: pathogen yield remains low, but blood/sputum cultures, PCR panels, and procalcitonin can help guide therapy in select patients. Viral pathogens (influenza, SARS-CoV-2, rhinovirus) are increasingly recognized, often in coinfection with bacteria.
Finally, we discuss special considerations:
Corticosteroids in severe CAP.
Transitioning safely to oral therapy.
Radiologic clues for atypical pathogens (Mycoplasma, Chlamydia, Legionella).
The importance of prevention through vaccination.
Whether you’re on service covering a busy inpatient unit or preparing for boards, this episode blends guideline-based recommendations with real-world pearls—helping you feel more confident in diagnosing, treating, and preventing complications from CAP.
