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Therefore we used it only as one of several definitions of severe CAP.
At this point, several features regarding prediction of severe CAP may be considered.
However, these results were shown in patients with severe CAP, defined as a class V Pneumonia Severity Index (PSI).
There are many definitions of severe CAP, and the best way to define severity is controversial.
Most patients were admitted for severe CAP (62.5%).
This low mortality shows that those patients did not have severe CAP.
Severe CAP (sCAP) was defined according to the American Thoracic Society guidelines [21].
Therefore, combination therapy with macrolides should be preferred for invasive mechanically ventilated patients with severe CAP.
In overall CAP patients, there are subsets of patients with severe CAP for whom combination therapy is clearly superior compared with monotherapy: severe CAP, bacteremic pneumococcal CAP, CAP with shock, and intubated CAP patients.
Conclusion The viral bacterial coinfection during severe CAP in adults is associated with an impaired presentation and an altered outcome.
Different factors may explain the superiority of combination therapy compared with monotherapy for the treatment of patients with severe CAP.
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