2018 recommendations for the management of community acquired pneumonia

Abstract

Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.

Clinical practice guidelines for the management of community‐acquired pneumonia: A critical appraisal using the AGREE II instrument

“…Then, 88 out of 4125 references were identified for possible inclusion, after 23 duplicated were removed, 38 papers were excluded (Figure ). Accordingly, 18 publications met our inclusion criteria …”

“…About the 18 CPGs selected: there is an American guideline (IDSA), one is from Brazil, one from Italy (Gulf), one from India, two European (ERS and Multidisciplinary), two from Spain (SEPAR and Andalusian), a Peruvian guideline, a Dutch guideline (SWAB), two British guidelines (NICE and BTS), a Lebanese guideline, one from Latin America (Consensur), one Colombian guideline, one Chinese, one Korean and one Swedish …”

“…Moreover, developers of CAP guidelines should involve individuals of all relevant areas, including specialists in internal medicine, infectious disease or pulmonologist, and the information of each author. The lowest score in this domain was obtained by the Brazilian and Andalusian . Despite having relevant professional groups, these guidelines do not describe the information of each author in detail as recommended.…”

“…Despite having relevant professional groups, these guidelines do not describe the information of each author in detail as recommended. Similarly, it is important to describe the target users of the guidelines, many of them do not do it, such as Swedish, Andalusian, SEPAR, Brazilian and Indian …”

High incidence of rhinovirus infection in children with community‐acquired pneumonia from a city in the Brazilian pre‐Amazon region

“…The study population, which comprised patients ranging in age from 3 months to 10 years (29.7 months of average), was selected according to protocol definitions and inclusion criteria. Pneumonia cases were defined using the Brazilian Society of Pneumology and Tisiology Guideline as follows: (a) presence of consolidation (a dense or fluffy opacity), pulmonary infiltrate (alveolar or interstitial densities), or pleural effusion on chest radiography; (b) two or more symptoms of acute lower respiratory tract illness, cough, fever, difficulty breathing, age‐adjusted tachypnea (≥50 breaths/min for children aged 2–11 months; ≥40 breaths/min for children aged ≥12 months) and/or wheezing. Severe pneumonia (severe CAP) was defined by the presence of lower chest concavity, inability to eat or drink, vomiting, convulsions, lethargy, unconsciousness, severe malnutrition, SpO 2 less than 90% by pulse oximetry, and/or central cyanosis.…”