What are the complications of pneumonia?

From the Guidelines

Pneumonia can lead to several serious complications, including respiratory failure, pleural effusion, lung abscesses, empyema, bacteremia, sepsis, and acute respiratory distress syndrome (ARDS), which can be life-threatening if not properly treated. The most common complications of pneumonia include:

• Respiratory failure, which occurs when the lungs cannot provide enough oxygen to the body
• Pleural effusion, where fluid accumulates between the lung and chest wall
• Lung abscesses (pockets of pus within the lung tissue) or empyema (pus in the pleural space)
• Bacteremia, where bacteria enter the bloodstream, can lead to sepsis, a life-threatening systemic inflammatory response
• Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure
• Metastatic infections like endocarditis or meningitis when the infection spreads to other organs
• Long-term complications may include persistent lung damage, decreased lung function, and increased risk of recurrent pneumonia

Elderly patients and those with underlying health conditions, such as chronic obstructive pulmonary disease (COPD), are particularly vulnerable to these complications 1. Early diagnosis and appropriate antibiotic therapy, such as amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days for community-acquired pneumonia, are essential to prevent these complications, along with supportive care including oxygen therapy, adequate hydration, and respiratory support when necessary 1.

The most recent study 1 highlights the importance of identifying the underlying pathogen and tailoring antibiotic therapy accordingly, as well as the need for prompt treatment to prevent the development of severe complications. Therefore, it is crucial to prioritize early diagnosis and treatment of pneumonia to prevent these potentially life-threatening complications.

From the Research

Complications of Pneumonia

• Pneumonia can lead to severe complications, especially in vulnerable populations such as children, older adults, and those with preexisting health conditions 2.
• Severe pneumonia can be acquired by previously healthy patients, those with pre-existing illness, or those hospitalized for an unrelated illness, and diagnosis is frequently difficult or delayed 3.
• The inflammatory response during pneumonia can lead to an increased risk of cardiovascular disease, with pneumonia survivors experiencing an accelerated health decline after infection 2.

Treatment-Related Complications

• The use of broad-spectrum antibiotics is recommended in the treatment of hospital-acquired pneumonia (HAP), but it remains controversial whether patients with early onset, non-ventilator HAP should also be empirically treated with broad-spectrum antibiotics 4.
• Combination antibiotic therapy, including a macrolide, can achieve a better outcome compared with monotherapy in patients with community-acquired pneumonia (CAP), especially in those with comorbidities, previous antibiotic therapy, or severe CAP 5.
• Macrolide resistance is common in Streptococcus pneumoniae, but the use of azithromycin remains associated with a reduction in in-hospital mortality, independent of macrolide resistance 6.

Long-Term Consequences

• Pneumonia survivors do not return to their preinfection health trajectories, but instead experience an accelerated health decline with an increased risk of cardiovascular disease 2.
• The mechanisms of this association are not well understood, but a persistent dysregulated inflammatory response post-pneumonia appears to play a central role 2.
• There is a need to better understand the inflammatory cross talk between the lungs and the heart during and after pneumonia to develop therapeutics that focus on preventing pneumonia-associated cardiovascular events 2.