Update of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent Adults

Abstract

These guidelines were developed and issued on behalf of the Infectious Diseases Society of America.A conflict of interest disclosure can be found at the end of the text.a Members of the Infectious Diseases Society of American Community-Acquired Pneumonia Committee; L.A.M., chair.

Diagnosis and Treatment of Community‐Acquired Pneumonia

“…However, the validity of these tests has recently been questioned after low positive culture rates were found (e.g., culture isolates of S. pneumoniae were present in only 40 to 50 percent of cases). 9 Such low positive culture rates are likely due to problems with retrieving samples from the lower respiratory tract, previous administration of antibiotics, contamination from the upper airways, faulty separation of sputum from saliva when streaking slides or plates, 9 or viral etiology. Furthermore, sputum samples are adequate in only 52.3 percent of patients with CAP, and only 44 percent of those samples contain pathogens.…”

“…15 Physicians should begin their treatment decisions by assessing the need for hospitalization using a prediction tool for increased mortality, such as the Pneumonia Severity Index (Table 3 Choosing between outpatient and inpatient treatment is a crucial decision because of the possible risk of death. 9,15,16 This decision not only influences diagnostic testing and medication choices, it can have a psychological impact on patients and their families. On average, the estimated cost for inpatient care of patients with CAP is $7,500.…”

“…[17][18][19] Hospitalization of a patient should depend on patient age, comorbidities, and the severity of the presenting disease. 9,20 Physicians tend to overestimate a patient's risk of death 14 ; therefore, many low-risk patients who could be safely treated as outpatients are admitted for more costly inpatient care. The Pneumonia Severity Index (Table 3 15 ) was developed to assist physicians in identifying patients at a higher risk of complications and who are more likely to benefit from hospitalization.…”

“…The Pneumonia Severity Index (Table 3 15 ) was developed to assist physicians in identifying patients at a higher risk of complications and who are more likely to benefit from hospitalization. 9,15,16 Investigators developed a risk model based on a prospective cohort study 16 of 2,287 patients with CAP in Pittsburgh, Boston, and Halifax, Nova Scotia. By using the model, the authors found that 26 to 31 percent of the hospitalized patients were good outpatient candidates, and an additional 13 to 19 percent only needed brief hospital observation.…”

“…[23][24][25][26][27] Further, patient evaluation should focus on severity of illness, patient age, comorbidities, clinical presentation, epidemiologic setting, and previous exposure. 9 The majority of patients with CAP are treated empirically based on the most common pathogen(s) associated with the condition. [23][24][25][26][27] Consensus guidelines from ATS, 8 Infectious Diseases Society of America, 9 and Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia 28 (Figure 1 6 ) recommend initial empiric therapy with macrolides, fluoroquinolones, or doxycycline (Vibramycin).…”