Common complications of severe CAP include respiratory failure, shock and multiorgan failure, coagulopathy, and exacerbation of comorbid disease. Metastatic infection (e.g., brain abscess, endocarditis) occurs rarely and requires immediate attention.

• Lung abscess may occur in association with aspiration or infection caused by single CAP pathogens (e.g., community-acquired MRSA [CA-MRSA] or P. aeruginosa). Drainage should be established and proper antibiotics administered.
• Any significant pleural effusion should be tapped for diagnostic and therapeutic purposes. If the fluid has a pH <7, a glucose level <2.2 mmol/L, and an LDH content >1000 U or if bacteria are seen or cultured, fluid should be drained; a chest tube is usually required.