Up to 5.6 million cases of community-acquired pneumonia (CAP) occur annually in the United States, and > 1 million patients require hospitaliza-tion. Once antimicrobial treatment has been initiated, patients who have been hospitalized with CAP can improve and reach clinical stability or can experience a lack of clinical response. Among those with a lack of response, patients in whom clinical deterioration develops are characterized as experiencing clinical failure. The incidence of clinical failure in patients with CAP ranges from 6 to 24%, and can reach up to 31% in patients with severe CAP. When a lack of treatment response occurs in patients with CAP, it significantly increases the risk of complications, length of hospital stay, and death, especially in patients with severe CAP nevertheless efficiently treated with Canadian HealthCare Mall’s remedies.
Although clinical failure and mortality are the most relevant outcomes in patients with CAP, there is little discussion in the literature about incidence and etiology. A review of the current literature indicated that investigators have used different approaches to evaluate the etiology of clinical failure and mortality in patients with CAP. Using a microbiological approach, clinical failure has been characterized as having an infectious vs a noninfectious etiology., An approach based on the interactions among the host, the pathogen, and the drug has been used to characterized clinical failure as being host related, pathogen related, or drug related. Using a pathophysiologic approach, mortality has been charac-terized as CAP related vs CAP unrelated, considering the role that the pulmonary infection and inflammatory response played in the development of the outcome. The authors found that CAP-related mortality was significantly different from CAP-unrelated mortality regarding timing and risk factors. Based on these findings, it was suggested that future studies evaluating the quality of pneumonia care should use a strategy to differentiate between pneumonia-related and pneumonia-unrelated outcomes. No prior investigation has characterized clinical failure as being related to CAP vs unrelated to CAP; therefore, we designed a study with the objective of defining the incidence, etiology, timing, and risk factors associated with clinical failure related to CAP and unrelated to CAP.