Complications

Complication
Timeframe
Likelihood
short term
medium

Commonly complicates severe CAP. Patients have fever, leukocytosis, tachypnoea, tachycardia. Can progress rapidly to multi-organ failure and shock. Follow your local protocol for investigation and treatment of all patients with suspected sepsis, or those at risk. Start treatment promptly. Determine urgency of treatment according to likelihood of infection and severity of illness, or according to your local protocol.[70][81]

Sepsis in adults

short term
medium

Pneumonia can be complicated by ARDS, which is a condition of non-cardiogenic pulmonary oedema and severe lung inflammation.

Associated with a 30% to 50% mortality, and treated with low tidal volume plateau pressure limited mechanical ventilation.[6]

Acute respiratory distress syndrome

short term
medium

May occur as a result of interruption of the normal bowel flora from antibiotic use. Patients generally have diarrhoea, abdominal pain, and leukocytosis. Stool immunoassay for C difficile enzymes is diagnostic. Ideally, causative antibiotics should be stopped, and treatment is with oral metronidazole, vancomycin, or fidaxomicin.

Clostridium difficile-associated disease

short term
medium

The incidence of heart failure in hospitalised patients with CAP was 14.1% in one study.[249] There is little information about risk factors for the occurrence of cardiac complications in patients with CAP. Older age, pre-existing congestive heart failure, severity of CAP, and the use of insulin by glucose sliding scales in hospitalised patients are possible risk factors.[250][251][252] In patients with known cardiovascular disease, use of pneumococcal and influenza vaccine may reduce morbidity and mortality.

short term
low

The incidence of acute coronary syndrome in hospitalised patients with CAP was 5.3% in one study.[249]

Overview of acute coronary syndrome

short term
low

The incidence of incident cardiac arrhythmia in hospitalised patients with CAP was 4.7% in one study.[249]

Overview of dysrhythmias (cardiac)

short term
low

Regarded as a rare complication of CAP in adults. Associated with pathogens such as Staphylococcus aureus, Streptococcus pyogenes, Nocardia species, Klebsiella pneumoniae, and Streptococcus pneumoniae.

Smoking, alcoholism, old age, diabetes mellitus, chronic lung diseases, or liver disease are risk factors associated with necrotising pneumonia.[256]

variable
high

May occur in up to 57% of hospitalised pneumonia patients.[253][254] About 1% to 2% of CAP cases with pleural effusion are complicated with empyema.

Pleural effusion is considered to be an indicator of pneumonia severity and is clearly associated with an increased risk of treatment failure.[1][255]

Pleural effusion

variable
low

A rare complication, frequently requiring prolonged antibiotic therapy and, in some cases, surgical drainage.

Lung abscess

variable
low

A rare complication of CAP in adults. Pneumothorax is associated with bacterial pneumonia caused by staphylococcus, streptococcus, and other type of bacteria, which may cause the collapse of a lung.

Pneumothorax

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