Challenges in severe community-acquired pneumonia

a point-of-view review

Antoni Torres, James D. Chalmers, Charles S. Dela Cruz, Cristina Dominedò, Marin Kollef, Ignacio Martin-Loeches, Michael Niederman, Richard G Wunderink

Research output: Contribution to journalReview article

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 languageEnglish (US)
Pages (from-to)159-171
Number of pages13
JournalIntensive Care Medicine
Volume45
Issue number2
DOIs
StatePublished - Feb 27 2019

Fingerprint

Pneumonia
Anti-Bacterial Agents
Oseltamivir
Methicillin Resistance
Macrolides
beta-Lactams
Enterobacteriaceae
Cephalosporins
Septic Shock
Human Influenza
Observational Studies
Meta-Analysis
Shock
Patient Care
Adrenal Cortex Hormones
Steroids
Morbidity
Mortality
Therapeutics

Keywords

  • Antibiotics
  • Multidrug resistance
  • Scoring systems
  • Septic shock
  • Severe community-acquired pneumonia
  • Viral pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Torres, A., Chalmers, J. D., Dela Cruz, C. S., Dominedò, C., Kollef, M., Martin-Loeches, I., ... Wunderink, R. G. (2019). Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Medicine, 45(2), 159-171. https://doi.org/10.1007/s00134-019-05519-y
Torres, Antoni ; Chalmers, James D. ; Dela Cruz, Charles S. ; Dominedò, Cristina ; Kollef, Marin ; Martin-Loeches, Ignacio ; Niederman, Michael ; Wunderink, Richard G. / Challenges in severe community-acquired pneumonia : a point-of-view review. In: Intensive Care Medicine. 2019 ; Vol. 45, No. 2. pp. 159-171.
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Torres, A, Chalmers, JD, Dela Cruz, CS, Dominedò, C, Kollef, M, Martin-Loeches, I, Niederman, M & Wunderink, RG 2019, 'Challenges in severe community-acquired pneumonia: a point-of-view review', Intensive Care Medicine, vol. 45, no. 2, pp. 159-171. https://doi.org/10.1007/s00134-019-05519-y

Challenges in severe community-acquired pneumonia : a point-of-view review. / Torres, Antoni; 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, 27.02.2019, p. 159-171.

Research output: Contribution to journalReview 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 - 2019/2/27

Y1 - 2019/2/27

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

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U2 - 10.1007/s00134-019-05519-y

DO - 10.1007/s00134-019-05519-y

M3 - Review article

VL - 45

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JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

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Torres A, Chalmers JD, Dela Cruz CS, Dominedò C, Kollef M, Martin-Loeches I et al. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Medicine. 2019 Feb 27;45(2):159-171. https://doi.org/10.1007/s00134-019-05519-y