TY - JOUR
T1 - ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia
AU - Martin-Loeches, Ignacio
AU - Torres, Antoni
AU - Nagavci, Blin
AU - Aliberti, Stefano
AU - Antonelli, Massimo
AU - Bassetti, Matteo
AU - Bos, Lieuwe
AU - Chalmers, James D.
AU - Derde, Lennie
AU - de Waele, Jan
AU - Garnacho-Montero, Jose
AU - Kollef, Marin
AU - Luna, Carlos
AU - Menendez, Rosario
AU - Niederman, Michael
AU - Ponomarev, Dmitry
AU - Restrepo, Marcos
AU - Rigau, David
AU - Schultz, Marcus J.
AU - Weiss, Emmanuel
AU - Welte, Tobias
AU - Wunderink, Richard
N1 - Publisher Copyright:
© 2023 European Respiratory Society. All rights reserved.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Background Severe community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and while European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP. Materials and methodology The European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Latin American Thoracic Association (ALAT) launched a task force to develop the first international guidelines for sCAP. The panel comprised a total of 18 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and treatment were chosen to be addressed. Systematic literature searches were performed in several databases. Meta-analyses were performed for evidence synthesis, whenever possible. The quality of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations. Results Recommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions. Conclusions In these international guidelines, ERS, ESICM, ESCMID and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made.
AB - Background Severe community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and while European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP. Materials and methodology The European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Latin American Thoracic Association (ALAT) launched a task force to develop the first international guidelines for sCAP. The panel comprised a total of 18 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and treatment were chosen to be addressed. Systematic literature searches were performed in several databases. Meta-analyses were performed for evidence synthesis, whenever possible. The quality of evidence was assessed with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations. Results Recommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions. Conclusions In these international guidelines, ERS, ESICM, ESCMID and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made.
UR - http://www.scopus.com/inward/record.url?scp=85146192895&partnerID=8YFLogxK
U2 - 10.1183/13993003.00735-2022
DO - 10.1183/13993003.00735-2022
M3 - Article
C2 - 37012080
AN - SCOPUS:85146192895
SN - 0903-1936
VL - 61
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 4
M1 - 2200735
ER -