The future is now in community-acquired pneumonia: cardiovascular complications and conjugate vaccines.

Recently, the ERS/ESCMID1 and SEPAR2 have published updated documents about the management of lower respiratory tract infections and community-acquired pneumonia (CAP). These are two clinically important issues that perhaps have not been sufficiently contemplated. The fact that our future actions for their treatment may be modified merits comment. Since 1993, different authors have published many reports about expected mortality in the long-term follow-up of patients who are hospitalized for CAP. The importance of defining the causes and planning clinical procedures that modify this tendency has been underlined by several authors.3 A recent example of this is the recent study by Bordon et al.,4 where reduced long-term survival was confirmed in patients who are hospitalized due to CAP and after adjusting for age and comorbidity with control subjects. Until now, perhaps the most relevant finding in the literature is that, in the follow-up of patients between the ages of 41 and 80 with no significant comorbidities, there is an observed trend in mortality that is higher than expected,5 and that said trend correlates with the Pneumonia Severity Index.6 The causes of this excessive mortality have not been sufficiently clarified, although we can try to relate different observations. It is known that there are important cardiac complications in a large proportion of patients with CAP.7 Along this line, Perry et al.8 have recently published that, in a very extensive population (50 119 subjects), a significant number of patients who were followed-up for 90 days after hospitalization for CAP presented a cardiovascular event, usually during hospitalization, these being: 1.5% AMI, 10.2% congestive heart failure, 9.5% arrhythmia, 0.8% unstable angina and 0.2% stroke. Likewise, Jasti et al.9 reported that most rehospitalizations after a CAP episode are the result of an underlying cardiopulmonary or neurological disease. Corrales-Medina et al.10 describe the association between acute bacterial pneumonia and acute coronary syndromes as well as the correlation between coagulation disorders and CAP.11