Abstract:
In Western Europe, which is experiencing progressive
population ageing, community-acquired pneumonia
(CAP) is the leading cause of death due to infection, with
approximately 90% of the mortality in adults occurring in
those aged >65 years (1). A similar situation exists in the
United States of America (2). The increasing frequency
of CAP in developed countries, predominantly among the
aged, has been paralleled by a growing rate of admissions to
intensive care units (ICUs), which has increased significantly
over the past 2–3 decades (3). Indeed CAP represents one of
the leading causes of admission to ICU, with between 13%
and 22% of patients hospitalised with CAP having been
reported to require ICU admission (4). Notwithstanding
the increasing burden of CAP associated with high-risk,
ageing populations, other factors which contribute to this
increase in the rate of ICU admissions include improved
access to modern health care facilities equipped with
sophisticated diagnostic and life-support technologies
and staffed by highly-trained critical care physicians and
nursing personnel. Another possible contributory factor is
the uptake of reliable, predictive clinical scoring systems,
specifically the pneumonia severity index (PSI) and the CURB-65 (3-5). Disappointingly, however, overall CAP-related
mortality rates remain high, ranging from 5–50%
according to geographic region (6,7), with the elderly, not
surprisingly, at particularly high risk (8-11).
