Book Review

Severe Community Acquired Pneumonia

N Engl J Med 2001; 345:1714December 6, 2001

Article

Severe Community Acquired Pneumonia
(Perspectives on Critical Care Infectious Diseases.) Edited by Jordi Rello and Kenneth V. Leeper. 208 pp., illustrated. Boston, Kluwer Academic, 2001. $175. ISBN: 0-7923-7338-3

Severe Community Acquired Pneumonia is part of a series entitled “Perspectives on Critical Care Infectious Diseases.” The editor states that “the specific objective of this Series is to update therapeutic implications and discuss controversial topics in specific infectious problems involving critically ill patients. Each topic will be discussed by two authors representing the different management perspectives for these controversial and evolving topics.” The book has 11 chapters: for each of five topics, 1 chapter was written from a North American perspective and the other from a European perspective (one pair of chapters, on the role of alcohol in severe pneumonia and acute lung injury, provides North American and South African perspectives). The one unpaired chapter discusses the problem of penicillin-resistant Streptococcus pneumoniae.

The book will be of value to the infectious-disease specialist, respirologist, or intensivist who deals with severe community-acquired pneumonia. It is easy to read and provides an up-to-date summary of a number of controversial areas in the care of patients with severe community-acquired pneumonia. The combination of two viewpoints on each topic results in very little incremental value — instead, there is considerable duplication in the second chapter on each topic. The editors would do well to reconsider this strategy. The same goals could be accomplished by having a commentary at the end of each chapter to provide another viewpoint.

An introductory chapter dealing with the definition, epidemiology, causes, and outcomes of severe community-acquired pneumonia would have been worthwhile. Instead, the book opens with two chapters on the management of respiratory failure in severe community-acquired pneumonia. These two chapters will be of value to the intensivist, since they deal with issues that relate to mechanical ventilation.

The approach after these first two chapters is to address Legionella pneumophila, penicillin-resistant S. pneumoniae, and the role of Pseudomonas aeruginosa in community-acquired pneumonia. All these microorganisms can cause severe community-acquired pneumonia, and some aspects of their management — such as the decision to include empirical therapy for P. aeruginosa in treating patients who present with severe community-acquired pneumonia — are controversial. The chapters on the problem of penicillin-resistant S. pneumoniae and the role of P. aeruginosa in community-acquired pneumonia are both good reviews of these topics. The last two chapters deal with the role of alcohol in severe pneumonia and acute lung injury and adjunctive therapies for severe community-acquired pneumonia.

The chapters that are likely to be most valuable to the reader are those on the role of alcohol in severe pneumonia and acute lung injury and on adjunctive therapies for severe community-acquired pneumonia. They provide excellent summaries of each subject and stand out by virtue of the fact that up-to-date reviews of these topics are not readily available in other sources. These two chapters alone make the book a worthwhile purchase. My disappointment with the book was that no effort was made to provide direction for future research in an area that suffers from the lack of a standard definition and a scarcity of evidence from randomized clinical trials.

Thomas J. Marrie, M.D.
University of Alberta, Edmonton, AB T6H 2B7, Canada
tom.marrie@ualberta.ca