Abstract
Purpose: Severe community-acquired pneumonia (SCAP) is still associated with substantial morbidity and mortality. In this point-of-view review paper, a group of experts discuss the main controversies in SCAP: the role of severity scores to guide patient settings of care and empiric antibiotic therapy; the emergence of pathogens outside the core microorganisms of CAP; viral SCAP; the best empirical treatment; septic shock as the most lethal complication; and the need for new antibiotics.
Methods: For all topics, the authors describe current controversies and evidence and provide recommendations and suggestions for future research. Evidence was based on meta-analyses, most recent RCTs and recent interventional or observational studies. Recommendations were reached by consensus of all the authors.
Results and Conclusions: The IDSA/ATS criteria remain the most pragmatic tool to predict ICU admission. The authors recommend a combination of a beta-lactam/beta-lactamase inhibitor or a third G cephalosporin plus a macrolide in most SCAP patients, and to empirically cover PES (P. aeruginosa, extended spectrum beta-lactamase producing Enterobacteriaceae, methicillin-resistant S. aureus) pathogens when at least two specific risk factors are present. In patients with influenza CAP, the authors recommend the use of oseltamivir and avoidance of the use of steroids. Corticosteroids can be used in case of refractory shock and high systemic inflammatory response.
| Original language | English |
|---|---|
| Pages (from-to) | 159-171 |
| Number of pages | 13 |
| Journal | Intensive Care Medicine |
| Volume | 45 |
| Issue number | 2 |
| Early online date | 31 Jan 2019 |
| DOIs | |
| Publication status | Published - Feb 2019 |
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Keywords
- Antibiotics
- Multidrug resistance
- Scoring systems
- Septic shock
- Severe community-acquired pneumonia
- Viral pneumonia
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}
Challenges in severe community-acquired pneumonia : a point-of-view review. / Torres, Antoni (Lead / Corresponding author); Chalmers, James D.; Dela Cruz, Charles S.; Dominedò, Cristina; Kollef, Marin; Martin-Loeches, Ignacio; Niederman, Michael; Wunderink, Richard G.
In: Intensive Care Medicine, Vol. 45, No. 2, 02.2019, p. 159-171.Research output: Contribution to journal › Review article
TY - JOUR
T1 - Challenges in severe community-acquired pneumonia
T2 - a point-of-view review
AU - Torres, Antoni
AU - Chalmers, James D.
AU - Dela Cruz, Charles S.
AU - Dominedò, Cristina
AU - Kollef, Marin
AU - Martin-Loeches, Ignacio
AU - Niederman, Michael
AU - Wunderink, Richard G.
PY - 2019/2
Y1 - 2019/2
N2 - Purpose: Severe community-acquired pneumonia (SCAP) is still associated with substantial morbidity and mortality. In this point-of-view review paper, a group of experts discuss the main controversies in SCAP: the role of severity scores to guide patient settings of care and empiric antibiotic therapy; the emergence of pathogens outside the core microorganisms of CAP; viral SCAP; the best empirical treatment; septic shock as the most lethal complication; and the need for new antibiotics.Methods: For all topics, the authors describe current controversies and evidence and provide recommendations and suggestions for future research. Evidence was based on meta-analyses, most recent RCTs and recent interventional or observational studies. Recommendations were reached by consensus of all the authors.Results and Conclusions: The IDSA/ATS criteria remain the most pragmatic tool to predict ICU admission. The authors recommend a combination of a beta-lactam/beta-lactamase inhibitor or a third G cephalosporin plus a macrolide in most SCAP patients, and to empirically cover PES (P. aeruginosa, extended spectrum beta-lactamase producing Enterobacteriaceae, methicillin-resistant S. aureus) pathogens when at least two specific risk factors are present. In patients with influenza CAP, the authors recommend the use of oseltamivir and avoidance of the use of steroids. Corticosteroids can be used in case of refractory shock and high systemic inflammatory response.
AB - Purpose: Severe community-acquired pneumonia (SCAP) is still associated with substantial morbidity and mortality. In this point-of-view review paper, a group of experts discuss the main controversies in SCAP: the role of severity scores to guide patient settings of care and empiric antibiotic therapy; the emergence of pathogens outside the core microorganisms of CAP; viral SCAP; the best empirical treatment; septic shock as the most lethal complication; and the need for new antibiotics.Methods: For all topics, the authors describe current controversies and evidence and provide recommendations and suggestions for future research. Evidence was based on meta-analyses, most recent RCTs and recent interventional or observational studies. Recommendations were reached by consensus of all the authors.Results and Conclusions: The IDSA/ATS criteria remain the most pragmatic tool to predict ICU admission. The authors recommend a combination of a beta-lactam/beta-lactamase inhibitor or a third G cephalosporin plus a macrolide in most SCAP patients, and to empirically cover PES (P. aeruginosa, extended spectrum beta-lactamase producing Enterobacteriaceae, methicillin-resistant S. aureus) pathogens when at least two specific risk factors are present. In patients with influenza CAP, the authors recommend the use of oseltamivir and avoidance of the use of steroids. Corticosteroids can be used in case of refractory shock and high systemic inflammatory response.
KW - Antibiotics
KW - Multidrug resistance
KW - Scoring systems
KW - Septic shock
KW - Severe community-acquired pneumonia
KW - Viral pneumonia
UR - http://www.scopus.com/inward/record.url?scp=85061015486&partnerID=8YFLogxK
U2 - 10.1007/s00134-019-05519-y
DO - 10.1007/s00134-019-05519-y
M3 - Review article
C2 - 30706119
VL - 45
SP - 159
EP - 171
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 2
ER -