Identifying predictors of treatment failure with community-acquired pneumonia: an update

INTRODUCTION: Treatment failure is a critical outcome in community-acquired pneumonia (CAP), especially in severe cases, where it increases the risk of complications, prolonged hospital stays and mortality. Treatment failure was reported between 4% and 32% in severe CAP cases. Identifying causes and risk factors for treatment failure is crucial as it enables timely modifications to antibiotic treatment, accurate identification of patients who may require admission to the intensive care unit, and implementation of appropriate management strategies. Understanding the underlying mechanisms and host responses leading to treatment failure is essential for improving patient outcomes. AREAS COVERED: The authors discuss the latest scientific evidence on treatment failure focusing on definition, risk factors, causes, etiology, and the role of biomarkers. This article is based on the available literature from PubMed. EXPERT OPINION: Early detection and timely initiation of proper antimicrobial therapy are key elements to prevent treatment failure and complications, ultimately reducing CAP-associated mortality. However, treatment failure requires a more nuanced approach: identifying and categorizing complications, understanding its timing (early vs. late), and recognizing main risk factors and biomarkers that could help predict, diagnose and monitor treatment failure as early as possible. A multidisciplinary approach is essential in the prevention of treatment failure.