Community-Acquired Bacterial Pneumonia (CABP)

What you can’t see can hurt them

Antibiotic resistance is a reality in CABP, a serious disease with costly, potentially deadly consequences.


49% pneumococcal resistance to current macrolides in the US1

Alan Evangelista, PhD, D(ABMM), St. Christopher’s Hospital for Children, Philadelphia, PA

Historically, there’s been a knee-jerk reaction to use azithromycin as a first-line drug. It does have some side effects, and it does, and one of the biggest ones from a microbiology point of view is a selection of resistance. It selects for resistance a lot faster than any other - than even the other macrolides...

Gregory Volturo, MD, FACEP, University of Massachusetts Medical School, Worcester, MA

In patients with severe pneumonia, very clearly that group, if they have a appropriate antibiotics-resistant organism, they're going to have an increased likelihood of failure and an increased mortality if we don't get them on the

Lionel Mandell, MD, FRCPC, McMaster University Medical School, Hamilton, Ontario, Canada

I think you've got to educate them that pneumonia is a serious problem, that there's increasing resistance, especially with the macrolides, and that you don't want to overuse the quinolones.

Gregory Volturo, MD, FACEP, University of Massachusetts Medical School, Worcester, MA

I don't believe that physicians really appreciate the mortality from pneumonia. It's common, and it's the leading cause of infectious death in adults. But because it is so common, we really don't, we don't think of the mortality being as high as it really is.

…in the emergency department, we will tend to see more of the sicker patients and have a little better appreciation for individuals—the risk of their death. And I will tell you, just in the past year, I've seen several patients that have come in, some young, very, very ill, and which they have died as a result of community-acquired pneumonia…

…So for some of us it is real.

Antibiotic resistance is a reality in community-acquired bacterial pneumonia

30% of pneumococcal isolates are just one mutation away from fluoroquinolone resistance.2-4
Antibiotic resistance may lead to serious consequences. In one study, resistant infections5:
  • More than doubled ICU admissions
  • Increased complications by 51%
According to the CDC, antibiotic resistant Streptococcus pneumoniae in the United States is responsible for6:
  • 1.2 million resistant infections per year
  • 19,000 excess hospitalizations

Pneumonia is the 2nd leading cause of hospitalization in the US7

The CDC has identified antibiotic resistant pneumococcal infections as a serious public health threat6

Each year in the United States, pneumonia is responsible for approximately:
  • 4.5 million ambulatory care visits8
  • 3.2 million emergency room visits9
  • 2.6 million hospitalizations9

The hospital readmission rate for pneumonia in the United States is 15.5%.10


Pneumonia causes an average of 1 death every 10 minutes in the US11

I don't think that people are necessarily as aware of the fact that community-acquired pneumonia leads to a lot of mortality. I think that a lot of people think about community-acquired pneumonia as being a relatively benign disease, but when you look at the actual numbers, and the 30-day mortality rate, they're astonishingly high. So I think that it flies under the radar. I think most people don't realize that this is one of the main causes of death in the United States.

What I really think about the community-acquired pneumonia is that everyone has to be aware that it's a very important disease. It's an important disease that is killing more people than any of the cardiovascular diseases around the world.

…since we started with penicillin in the 1950s, the mortality has remained the same, then we have not shown really a great impact in decreasing mortality of community-acquired pneumonia…

Pneumonia is killing people, and it's killing people around the world. It's killing all people, it's killing young people, it's killing people who are 32 years old.

It's killing too many people, and we need to improve outcomes in pneumonia.

Community-Acquired Bacterial Pneumonia can have deadly consequences

Pneumonia is the 8th leading cause of death in the US, accounting for more than 53,000 deaths each year (2013).11,12
  • It is responsible for more deaths than breast cancer or prostate cancer11

Inpatient mortality rates are as high as 23% in North America.13


Pneumonia is the 8th most costly inpatient condition14

The real driver of healthcare costs in patients who have pneumonia is the patient who is treated inappropriately, fails their clinical treatment, and ends up going to the hospital and gets admitted for further management. So the true drivers of cost are treatment failure, not the acquisition costs of an antibiotic.

So does the treatment of CAP, should it be in the community, and it really definitely should be as much as possible. So one of the main drivers of cost of care is hospitalization, so if you look at any study of cost of care for any condition, the biggest driver is always hospitalization.

Cost, I think, only plays a role in the sense that everybody understands that there is a dramatic change in the cost of management when a patient gets admitted to the hospital, and so, I think the role that payers play is they don't want to see patients admitted to the hospital unnecessarily, and the other real pressure related to cost right now relates to readmission…

The cost of Community-Acquired Bacterial Pneumonia is alarming

The associated costs of pneumonia in the United States exceed $17 billion each year.13

A single CABP hospitalization in the United States can cost as much as $21,086 (2013).9

Antibiotic resistant pneumococcal infections lead to $96 million in excess medical costs each year.6