With several recent studies impacting our diagnostic and therapeutic approach for CAP, the American Journal of Respiratory and Critical Care Medicine just released a set of updated guidelines. This post will take you through the relevant ED recommendations on testing, disposition, and antibiotic therapy. For more, see the open access article at ATS Journals. Do not routinely obtain sputum Gram stain and culture in adults with CAP managed as outpatients strong recommendation, very low quality of evidence. Do not obtain blood cultures for patients with CAP managed as outpatients strong recommendation, very low quality of evidence , and do not routinely obtain blood cultures in those admitted conditional recommendation, very low quality of evidence. Test for Legionella urinary antigen and collect lower respiratory tract secretions for culture or nucleic acid amplification testing NAAT in severe CAP conditional recommendation, low quality of evidence.
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Metlay, Grant W. Waterer, Ann C. Cooley, Nathan C. Dean, Michael J. Fine, Scott A. Flanders, Marie R. Griffin, Mark L. Metersky, Daniel M. Musher, Marcos I. Restrepo, and Cynthia G. Whitney; on behalf of the American Thoracic Society and Infectious Diseases Society of America Abstract Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.
Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.
Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia. Additional Resources.
Community-Acquired Pneumonia: ATS/IDSA Guidelines Update
Search Menu Executive Summary Improving the care of adult patients with community-acquired pneumonia CAP has been the focus of many different organizations, and several have developed guidelines for management of CAP. The guidelines are intended primarily for use by emergency medicine physicians, hospitalists, and primary care practitioners; however, the extensive literature evaluation suggests that they are also an appropriate starting point for consultation by specialists. Substantial overlap exists among the patients whom these guidelines address and those discussed in the recently published guidelines for health care-associated pneumonia HCAP. Pneumonia in nonambulatory residents of nursing homes and other long-term care facilities epidemiologically mirrors hospital-acquired pneumonia and should be treated according to the HCAP guidelines. However, certain other patients whose conditions are included in the designation of HCAP are better served by management in accordance with CAP guidelines with concern for specific pathogens. Implementation of Guideline Recommendations. Locally adapted guidelines should be implemented to improve process of care variables and relevant clinical outcomes.
Improving the 2007 IDSA/ATS severe Community-Acquired Pneumonia criteria to predict ICU admission
The AUC increased from 0. Moreover, there are variations in the strength of association between individual minor criteria and other selected variables identifying the need of ICU admission. The need to identify prediction rules that determine when a patient with severe CAP requires ICU care are limited because they were designed to predict day mortality and therefore, it has been used as marker for the need of a higher level of care. Liapikou et al. The value of these criteria has not been firmly established in order to predict ICU care. We suggest that adding more minor criteria variables does not have the same value as adding a low arterial pH to the prediction score.