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Challenges in severe community-acquired pneumonia: a point-of-view review

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 therap...

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Autores principales: Torres, Antoni, Chalmers, James D., Dela Cruz, Charles S., Dominedò, Cristina, Kollef, Marin, Martin-Loeches, Ignacio, Niederman, Michael, Wunderink, Richard G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094947/
https://www.ncbi.nlm.nih.gov/pubmed/30706119
http://dx.doi.org/10.1007/s00134-019-05519-y
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author Torres, Antoni
Chalmers, James D.
Dela Cruz, Charles S.
Dominedò, Cristina
Kollef, Marin
Martin-Loeches, Ignacio
Niederman, Michael
Wunderink, Richard G.
author_facet Torres, Antoni
Chalmers, James D.
Dela Cruz, Charles S.
Dominedò, Cristina
Kollef, Marin
Martin-Loeches, Ignacio
Niederman, Michael
Wunderink, Richard G.
author_sort Torres, Antoni
collection PubMed
description 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.
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spelling pubmed-70949472020-03-26 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. Intensive Care Med Review 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. Springer Berlin Heidelberg 2019-01-31 2019 /pmc/articles/PMC7094947/ /pubmed/30706119 http://dx.doi.org/10.1007/s00134-019-05519-y Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2019 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review
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
title Challenges in severe community-acquired pneumonia: a point-of-view review
title_full Challenges in severe community-acquired pneumonia: a point-of-view review
title_fullStr Challenges in severe community-acquired pneumonia: a point-of-view review
title_full_unstemmed Challenges in severe community-acquired pneumonia: a point-of-view review
title_short Challenges in severe community-acquired pneumonia: a point-of-view review
title_sort challenges in severe community-acquired pneumonia: a point-of-view review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094947/
https://www.ncbi.nlm.nih.gov/pubmed/30706119
http://dx.doi.org/10.1007/s00134-019-05519-y
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