Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

Metlay, Joshua P.; Waterer, Grant; Long, Alan; Anzueto, Antonio; Brožek, Jan; Crothers, Kristina; Cooley, Laura A.; Dean, Nathan C.; Fine, Michael J.; Flanders, Scott A.; Griffin, Marie R.; Metersky, Mark L.; Musher, Daniel M.; Restrepo, Marcos I.; Whitney, Cynthia G.

doi:10.1164/rccm.201908-1581st

Cited by 2,378 publications

(2,675 citation statements)

References 206 publications

(203 reference statements)

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“…Each of the five lung lobes was assessed for degree of involvement and classified as none (0%), minimal (1 -25%), mild (26 -50%), moderate (51 -75%), or severe (76 -100%). None corresponded to a lobe score of 0, minimal to a lobe score of 1, mild to a lobe score of 2, moderate to a lobe score of 3, and severe to a lobe score of 4 [9,10]. 5(31%) of 16 patients reached a lobe score of 4 in the combination group and 6(35%) of 17 in the monotherapy group in baseline characteristics, and there is no statistically significant differences between two groups (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Arbidol combined with LPV/r versus LPV/r alone against Corona Virus Disease 2019: A retrospective cohort study

Deng

Zeng

et al. 2020

Journal of Infection

461

463

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Highlights Patients were given oral arbidol and LPV/r in the combination group and oral LPV/r only in the monotherapy group for 5-21 days  Our study shows that oral arbidol and LPV/r in the combination group is associated with a significant elevated negative conversion rate of coronavirus' test in 7-day and 14-day, compared with LPV/r only in the monotherapy group. Combination therapy is associated with a significantly improved the chest CT scans in 7-day. We suppose that reducing the viral load as soon as possible could benefit the delay of the progression of lung lesions. Abstract BackgroundCorona Virus Disease 2019 (COVID-19) due to the 2019 novel coronavirus (SARS-CoV-2) emerged in Wuhan city and rapidly spread throughout China. We aimed to compare arbidol and lopinavir/ritonavir(LPV/r) treatment for patients with COVID-19 with LPV/r only. MethodsIn this retrospective cohort study, we included adults (age≥18years) with laboratory-confirmed COVID-19 without Invasive ventilation, diagnosed between Jan 17, 2020, and Feb 13, 2020. Patients, diagnosed after Jan 17, 2020, were given oral arbidol and LPV/r in the combination group and oral LPV/r only in the monotherapy group for 5-21 days. The primary endpoint was a negative conversion rate of coronavirus from the date of COVID-19 diagnosis(day7, day14), and assessed whether the pneumonia was progressing or improving by chest CT (day7). ResultsWe analyzed 16 patients who received oral arbidol and LPV/r in the combination group and 17 who oral LPV/r only in the monotherapy group, and both initiated after diagnosis. Baseline clinical, laboratory, and chest CT characteristics were similar between groups. The SARS-CoV-2 could not be detected for 12(75%) of 16 patients' nasopharyngeal specimens in the combination group after seven days, compared with 6 (35%) of 17 in the monotherapy group (p<0·05). After 14 days, 15 (94%) of 16 and 9 (52·9%) of 17, respectively, SARS-CoV-2 could not be detected (p<0·05). The chest CT scans were improving for 11(69%) of 16 patients in the combination group after seven days, compared with 5(29%) of 17 in the monotherapy group (p<0·05). ConclusionIn patients with COVID-19, the apparent favorable clinical response with arbidol and LPV/r supports further LPV/r only.

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Section: Resultsmentioning

confidence: 99%

Arbidol combined with LPV/r versus LPV/r alone against Corona Virus Disease 2019: A retrospective cohort study

Deng

Zeng

et al. 2020

Journal of Infection

461

463

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“…Used in conjunction with the history and physical examination, in the ED setting an abnormal CRP could identifying patients who should have a CXR, while a normal CRP could support clinical decisions not to prescribe an antibiotic. While radiographic pneumonia may be viral, it is still the standard of care in the United States to treat these patients with an antibiotic …”

Section: Discussionmentioning

confidence: 99%

“…Masking of radiologists to the index test result was unclear in five studies and absent in one. Also, CXRs are less accurate than chest CT, and radiographic pneumonia is not the same as bacterial pneumonia, although U.S. guidelines do recommend antibiotics for patients with radiographic pneumonia . In general, these potential biases are thought to inflate sensitivity and specificity.…”

Section: Limitationsmentioning

confidence: 99%

Accuracy of Biomarkers for the Diagnosis of Adult Community‐acquired Pneumonia: A Meta‐analysis

Ebell

Bentivegna

Cai

et al. 2020

Academic Emergency Medicine

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Background Biomarkers such as C‐reactive protein (CRP) and procalcitonin may help distinguish community‐acquired pneumonia (CAP) from other causes of lower respiratory tract infection. Methods We performed a systematic review of the literature to identify prospective studies evaluating the accuracy of a biomarker in patients with acute cough or suspected CAP. We performed parallel abstraction of data regarding study inclusion, characteristics, quality, and test accuracy. Study quality was evaluated using QUADAS‐2. Bivariate meta‐analysis was performed using the mada package in R, and summary receiver operating characteristic (ROC) curves were created. Results Fourteen studies met our inclusion and exclusion criteria; three were at low risk of bias and four at moderate risk of bias, largely due to failure to prespecify diagnostic thresholds. Considering all studies regardless of the cutoff used, CRP was most accurate (area under the ROC curve = 0.802), followed by leukocytosis (0.777) and procalcitonin (0.771). Lipopolysaccharide‐binding protein and fibrinogen are promising, but were only studied in a single report. For CRP and procalcitonin, the positive and negative likelihood ratios (LR+ and LR–, respectively) varied inversely based on the cutoff. For CRP, LR+ and LR− were 2.08 and 0.32 for a cutoff of 20 mg/L, 3.64 and 0.36 for a cutoff of 50 mg/L, and 5.89 and 0.47 for a cutoff of 100 mg/L. For procalcitonin, LR+ and LR− were 2.50 and 0.39 for a cutoff of 0.10 µg/L, 5.43 and 0.62 for a cutoff of 0.25 µg/L, and 8.25 and 0.76 for a cutoff of 0.50 µg/L. The combination of CRP >49.5 mg/L and procalcitonin >0.1 µg/L had LR+ of 2.24 and LR− of 0.44. Conclusions The best evidence supports CRP as the preferred biomarker for diagnosis of outpatient CAP given its accuracy, low cost, and point‐of‐care availability.

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“…Since 2003, the IDSA CAP guideline has been revised twice: 2007 49 and 2019. 50 Neither guideline made any recommendation for the treatment of NHAP in the nursing home. The 2007 guideline recommended that nursing home residents admitted to the hospital with pneumonia be treated according to the 2005 ATS/IDSA guideline as a HCAP, but made no recommendations for treatment in the nursing home.…”

Section: Treatment Regimensmentioning

confidence: 99%

Nursing Home-Associated Pneumonia, Part II: Etiology and Treatment

Mylotte

2020

Journal of the American Medical Directors Association

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a b s t r a c tThis is the second of 2 parts of a narrative review of nursing home-associated pneumonia (NHAP) that deals with etiology and treatment in the nursing home. In the 1980s and 1990s, the etiology of NHAP was considered to be similar to community-acquired pneumonia (CAP). This belief was reflected in CAP guidelines until 2005 when the designation healthcare-associated pneumonia or HCAP was introduced and nursing home residents were included in the HCAP category. Patients in the HCAP group were thought to be at high risk for pneumonia because of multidrug resistant organisms and required empiric broad-spectrum antibiotic therapy much like people with hospital-acquired infection. Subsequent studies of the etiology of NHAP using sophisticated diagnostic testing found limited evidence of resistant organisms such as methicillin-resistant Staphylococcus aureus or resistant gram-negative organisms or atypical organisms. In terms of management of NHAP in the nursing home there are several considerations that are discussed: hospitalization decision, initial oral or parenteral therapy, timing of switch to an oral regimen if parenteral therapy is initially prescribed, duration of therapy with an emphasis on shorter courses, and follow-up during therapy including the use of the "antibiotic time out" protocol. The oral and parenteral antibiotic regimens recommended for treatment of NHAP in this report are based on limited information because there are no randomized controlled trials to define the optimum regimen. In conclusion, most residents with pneumonia can be treated successfully in the nursing home. However, there is an urgent need for a specific NHAP diagnosis and treatment guideline that will give providers guidance in the management of this infection in the nursing home.

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Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

Cited by 2,378 publications

References 206 publications

Arbidol combined with LPV/r versus LPV/r alone against Corona Virus Disease 2019: A retrospective cohort study

Arbidol combined with LPV/r versus LPV/r alone against Corona Virus Disease 2019: A retrospective cohort study

Accuracy of Biomarkers for the Diagnosis of Adult Community‐acquired Pneumonia: A Meta‐analysis

Nursing Home-Associated Pneumonia, Part II: Etiology and Treatment

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