International Perspective on the New 2019 American Thoracic Society/Infectious Diseases Society of America Community-Acquired Pneumonia Guideline: A Critical Appraisal by a Global Expert Panel.
- Pletz MW Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany (member of the CAPNETZ Foundation). Electronic address: mathias.pletz@med.uni-jena.de.
- Blasi F Respiratory Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
- Chalmers JD Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland.
- Dela Cruz CS Pulmonary Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Yale University School of Medicine, New Haven, CT.
- Feldman C Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Luna CM Pulmonary Diseases Division, Department of Medicine, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
- Ramirez JA Division of Infectious Diseases, Department of Medicine, University of Louisville Health Sciences Center, Louisville, KY.
- Shindo Y Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
- Stolz D Pneumology and Pulmonary Cell Research, Departments of Respiratory Medicine and Biomedicine, University of Basel and University Hospital Basel, Basel, Switzerland.
- Torres A Servei de Pneumologia, Hospital Clinic, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Institució Catalana de Recerca i Estudis Avançats (ICREA) Academia, Barcelona, Spain.
- Webb B Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT.
- Welte T Department of Respiratory Medicine, Hannover Medical School (member of the German Center of Lung Research and the CAPNETZ Foundation), Hannover, Germany.
- Wunderink R Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
- Aliberti S Respiratory Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
- 2020-08-29
Published in:
- Chest. - 2020
English
In 2019, the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) issued a substantial revision of the 2007 guideline on community-acquired pneumonia (CAP). Despite the fact that generalization of infectious disease guidelines is limited because of substantial geographic differences in microbiologic etiology and antimicrobial resistance, the ATS/IDSA guideline is frequently applied outside the United States. Therefore, this project aimed to give a perspective on the ATS/IDSA CAP recommendations related to the management of CAP outside the United States. For this, an expert panel composed of 14 international key opinion leaders in the field of CAP from 10 countries across five continents, who were not involved in producing the 2019 guideline, was asked to subjectively name the five most useful changes, the recommendation viewed most critically, and the recommendation that cannot be applied to their respective region. There was no formal consensus process, and the article reflects different opinions. Recommendations welcomed by most of the international pneumonia experts included the abandonment of the concept of "health-care-associated pneumonia," the more restrictive indication for empiric macrolide treatment in outpatients, the increased emphasis on microbiologic diagnostics, and addressing the use of corticosteroids. Main criticisms included the somewhat arbitrary choice of a 25% resistance threshold for outpatient macrolide monotherapy. Experts from areas with elevated mycobacterial prevalence particularly opposed the recommendation of fluoroquinolones, even as an alternative.
- Language
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- English
- Open access status
- bronze
- Identifiers
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- DOI 10.1016/j.chest.2020.07.089
- PMID 32858009
- Persistent URL
- https://sonar.ch/global/documents/35298
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