Mar 1;44 Suppl 2:S America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Keywords: Community-acquired pneumonia, ICU admission, arterial .. The IDSA/ATS CAP Guidelines major criteria including the pH. Pneumonia In Adults Adapted from: IDSA/ATS CONSENSUS GUIDELINES Mandell LA, Wunderlink RG, Anzueto A, et al. Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis. ;(Suppl 2).

Author: Mojin Mikakinos
Country: Yemen
Language: English (Spanish)
Genre: Music
Published (Last): 4 March 2007
Pages: 477
PDF File Size: 4.4 Mb
ePub File Size: 17.94 Mb
ISBN: 819-5-12176-209-2
Downloads: 62703
Price: Free* [*Free Regsitration Required]
Uploader: Fegore

An alternative explanation is the immunomodulatory effects of macrolides []. Guidelines for the treatment of pneumonia must use approaches that differ from current practice and must be successfully implemented before process of care and outcomes can change. Further studies are needed to determine how to improve current methods that may be translated commujity earlier care and improve CAP patient outcomes. A respiratory fluoroquinolone should be used for penicillin-allergic patients.

False-positive blood culture results are associated with prolonged hospital stay, possibly related to changes in management based on preliminary results showing gram-positive cocci, which eventually prove to be coagulase-negative staphylococci [ 95].

The same findings on preliminary results of blood cultures are not as reliable, because of the significant risk of contamination afquired 95 ]. When compared in the same population, the PSI classified a slightly larger percentage of patients with CAP in the low-risk categories, compared with the CURB or CURB criteria, while remaining associated with a similar low mortality rate among patients categorized as low risk [ 56 ].

However, respiratory syncytial virus RSV can cause a similar syndrome and often occurs in the same clinical scenario [ ].

Author manuscript; available in PMC Jun 1. Despite advances ckmmunity antimicrobial therapy, rates of mortality due to pneumonia have not decreased significantly since penicillin became routinely available [ 3 ].

The best indicator of S.


IDSA CAP Guidelines

The initial study suggested a breakpoint of 8 h [ ], whereas the subsequent analysis found that 4 h was associated with lower mortality [ ]. Early treatment within 48 h of onset of symptoms with oseltamivir or zanamivir is recommended for influenza A. More concerning is a recent study suggesting that many outpatients given a fluoroquinolone may not have even required an antibiotic, that the dose and duration of treatment were often incorrect, and that another agent often should have been used as first-line therapy.

One of the most important determinants of the need for ICU care is the presence of chronic comorbid conditions [ 68—72 ]. Cases of pneumonia that are of public health concern should be reported immediately to the state or local health department. National hospital discharge survey: Direct admission to an ICU is required for patients with septic shock requiring vasopressors or with acute respiratory failure requiring intubation and mechanical ventilation.

The AUC increased from 0.

IDSA CAP Guidelines

Acquires, none guidelinex the published criteria for severe CAP adequately distinguishes these patients from those for whom ICU admission is necessary. Unfortunately, tracheal aspirates were obtained from only a third of patients in the control group, but they all were culture positive. Also, the presence of rare illnesses, such as neuromuscular or sickle cell disease, may require hospitalization but not affect the PSI score.

The exception may be endemic fungi in the appropriate geographic distribution [ ].

The cost-benefit ratio is even worse when antibiotic therapy is fuidelines streamlined when possible [] or when inappropriate escalation occurs [ 95 ]. Previously healthy and no risk factors for drug-resistant S. Community-acquired pneumonia, ICU admission, arterial acidosis, severity scores. BUN, blood urea nitrogen; CI, confidence interval; inf.

Practice Guidelines

The possibility of polymicrobial CAP and the potential benefit of combination therapy for bacteremic pneumococcal pneumonia have complicated the decision to narrow antibiotic therapy. The final grading of each recommendation was a composite of the individual committee members’ grades.


The lack of benefit overall in this trial should not be interpreted as a lack of benefit for an individual patient.

Mortality and morbidity among these patients appears to be greater than those among patients admitted directly to the ICU. For example, not all investigators have found it necessary to have the white blood cell count improve. Results Among patients hospitalized with CAP, Strong recommendation; level I evidence.

The relative merits and limitations of various proposed criteria have been carefully evaluated [ 49 ]. The PSI is based on derivation and validation cohorts of 14, and 38, hospitalized patients with CAP, respectively, plus an additional combined inpatients and outpatients [ 42 ].

Community Acquired Pneumonia Guidelines

Several criteria have been proposed to define severe CAP. Once again, patients with CAP made up a significant fraction of patients entered into the trial. In addition to patients who required hospital admission because of hypoxemia, a subsequent study identified patients in low PSI risk classes I—III who needed hospital admission because of shock, decompensated coexisting illnesses, pleural effusion, inability to maintain oral intake, social problems the patient was dependent or no caregiver was availableand lack of response to previous adequate empirical antibiotic therapy [ 64 ].

Although influenza remains the predominant viral cause of CAP in adults, other ocmmunity recognized viruses include RSV [ ], adenovirus, and parainfluenza virus, as well as less common viruses, including human metapneumovirus, herpes simplex virus, varicella-zoster virus, Pneumoniz coronavirus, and measles virus.

Because overall efficacy remains good for many classes of agents, the more potent drugs are given preference because of their benefit in decreasing the risk of selection for antibiotic resistance. The cost of treating community-acquired pneumonia.

iPhone X