The main outcomes of interest were the predictive capacity of severe CAP criteria for ICU admission and hospital mortality and the impact of ICU admission on hospital mortality for patients who met only minor severity criteria and no major criteria. Your comment will be reviewed and published at the journal's discretion. This suggests that too many patients with septic shock were admitted to hospital wards when they might have benefitted from ICU admission instead. Please see below. Background: The 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) guidelines defined severe community-acquired pneumonia (CAP) and recommended intensive care unit (ICU) admission when patients fulfilled three out of nine minor criteria. progression to severe sepsis (odds ratios [ORs], 0.65 and 0.89 for two or more SIRS criteria and three or more SIRS criteria, respectively), septic shock (ORs, 0.80 and 0.55), or death (ORs, 0.65 and 0.39), with poor discrimination (all receiver operating characteristic [ROC] areas under the Part of the problem has been that there has not been a universally agreed upon definition of severe CAP. The reader is referred to the IDSA/ATS CAP guidelines for a discussion of the minor criteria and the reasons for their inclusion [11]. The site of care determines the type and extent of diagnostic testing, the spectrum and route of administration of antibiotics, and the overall treatment costs. For patients initially treated with parenteral antibiotics, the switch to an oral regimen should occur as soon as clinical improvement occurs and temperature has been normal for 24 hours. Diagnosis can still be made within 48 h of hospital admission to meet criteria for a community-acquired infection. Severe pneumonia was defined as admission to the intensive care unit (ICU). It is the dedication of healthcare workers that will lead us through this crisis. An examination of North American guidelines published over the past 14 years shows a process that has been slowly but progressively evolving. 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The ATS guidelines of 2001 modified the definition of severe CAP to include the presence of ⩾2 minor criteria (respiratory rate ⩾30 breaths per min, ratio of arterial oxygen tension to inspired oxygen fraction <250, bilateral or multilobar pneumonia, systolic blood pressure ⩽90 mm Hg, and diastolic blood pressure ⩽60 mm Hg) or the presence of 1 major criterion (the need for mechanical ventilation, septic shock or the need for vasopressors for >4 h, an increase in the size of infiltrates by >50% within 48 h, and acute renal failure). A number of criteria have been developed over the years to help with the definition of severe CAP and/or to identify patients who require admission to an ICU. Whether the detection of infiltrates in the chest radiographs of patients with acute lower respiratory tract infection (LRTI) suggestive of mild pneumonia has an independent prognostic impact ICU facilities, resources, and personnel are relatively limited in most hospitals. Ideally, we would like to identify patients who require ICU care as early as possible. One thousand six hundred thirty-seven consecutive patients with CAP were assessed and 26 cases were excluded from the cohort due to exclusion criteria. Therefore, the inappropriate admission to the ICU of patients with CAP who do not require such care may prevent a patient who does require such care from accessing it. Requirement of vasopressors > 4 h (septic shock), 4. doi: 10.1164/rccm.201908-1581ST. Community acquired pneumonia requiring hospitalisation: 5-year prospective study. Such an approach, however, resulted in a definition that was extremely sensitive but not specific [8]. Oxford University Press is a department of the University of Oxford. Severe CAP is defined as the presence of one major criterion or at least three minor criteria. , resulted in a subsequent article, confirmed the ability of the article by Liapikou et al 10 to. 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