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Semin Respir Crit Care Med 2012; 33(03): 298-310
DOI: 10.1055/s-0032-1315642
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Community-Acquired Pneumonia Guidelines: A Global Perspective

Michael S. Niederman
1   Department of Medicine, Winthrop University Hospital, Mineola, New York.
2   Department of Medicine, SUNY (State University of New York) at Stony Brook, Stony Brook, New York.
,
Carlos M. Luna
3   Pulmonary Diseases Division, Department of Medicine, Hospital de Clinicas, Buenos Aires, Argentina.
4   Department of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina.
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Publikationsdatum:
20. Juni 2012 (online)

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Abstract

Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality worldwide, and since 1993, guidelines for management have been available. The process, which first began in the United States and Canada, has now been implemented in numerous countries throughout the world, and often each geographic region or country develops locally specific recommendations. It is interesting to realize that guidelines from different regions often interpret the same evidence base differently, and guidelines differ from one country to another, even though the bacteriology of CAP is often more similar than different from one region to another. One of the unique contributions of the 2007 US guidelines is the inclusion of quality and performance measures. In addition, US guidelines emphasize management principles that differ from some of the principles in European guidelines because of unique epidemiological considerations. In addition, certain therapy principles apply in the United States that differ from those in other regions, including the need for all patients to receive routine therapy for atypical pathogens, the emergence of community-acquired methicillin-resistant Staphylococcus aureus in some patients following influenza, and the need for all patients admitted to the intensive care unit to receive at least two antimicrobial agents. In the future, as guidelines evolve, there will be an important place for regional guidelines, particularly if these guidelines can recommend locally specific strategies to implement guidelines, which if successful, can lead to improved patient outcomes.

Keywords

pneumonia - drug-resistance - Streptococcus pneumoniae - Staphylococcus aureus - performance measures - guidelines - prognostic scoring - diagnostic testing
 

  • References

  • 1 World Health Organization, Department of Health Statistics and Informatics. Estimates of Deaths by Cause for the Year 2008. 2008 http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf . Accessed May 30, 2012
    PubMedGoogle Scholar
  • 2 Niederman MS, Bass Jr JB, Campbell GD , et al; American Thoracic Society. Medical Section of the American Lung Association. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Am Rev Respir Dis 1993; 148 (5) 1418-1426
    CrossrefPubMedGoogle Scholar
  • 3 Örtqvist A. Treatment of community-acquired lower respiratory tract infections in adults. Eur Respir J Suppl 2002; 36: 40s-53s
    PubMedGoogle Scholar
  • 4 Arnold FW, LaJoie AS, Brock GN , et al; Community-Acquired Pneumonia Organization (CAPO) Investigators. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. Arch Intern Med 2009; 169 (16) 1515-1524
    CrossrefPubMedGoogle Scholar
  • 5 Blasi F, Iori I, Bulfoni A, Corrao S, Costantino S, Legnani D. Can CAP guideline adherence improve patient outcome in internal medicine departments?. Eur Respir J 2008; 32 (4) 902-910
    CrossrefPubMedGoogle Scholar
  • 6 Capelastegui A, España PP, Quintana JM , et al. Improvement of process-of-care and outcomes after implementing a guideline for the management of community-acquired pneumonia: a controlled before-and-after design study. Clin Infect Dis 2004; 39 (7) 955-963
    CrossrefPubMedGoogle Scholar
  • 7 Shorr AF, Bodi M, Rodriguez A, Sole-Violan J, Garnacho-Montero J, Rello J ; CAPUCI Study Investigators. Impact of antibiotic guideline compliance on duration of mechanical ventilation in critically ill patients with community-acquired pneumonia. Chest 2006; 130 (1) 93-100
    CrossrefPubMedGoogle Scholar
  • 8 European Respiratory Society. ERS Task Force Report. Guidelines for management of adult community-acquired lower respiratory tract infections. Eur Respir J 1998; 11 (4) 986-991
    CrossrefPubMedGoogle Scholar
  • 9 Woodhead M, Blasi F, Ewig S , et al; European Respiratory Society; European Society of Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26 (6) 1138-1180
    CrossrefPubMedGoogle Scholar
  • 10 Höffken G, Lorenz J, Kern W , et al; Paul-Ehrlich-Gesellschaft für Chemotherapie; Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin; Deutschen Gesellschaft für Infektiologie und vom Kompetenznetzwerk CAPNETZ. Epidemiology, diagnosis, antimicrobial therapy and management of community-acquired pneumonia and lower respiratory tract infections in adults. Guidelines of the Paul-Ehrlich-Society for Chemotherapy, the German Respiratory Society, the German Society for Infectiology and the Competence Network CAPNETZ Germany [in German]. Pneumologie 2009; 63 (10) e1-e68
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Alfageme I, Aspa J, Bello S , et al; Grupo de Estudio de la Neumonía Adquirida en la Comunidad. Area de Tuberculosis e Infecciones Respiratorias (TIR)-SEPAR; Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Guidelines for the diagnosis and management of community-acquired pneumonia[in Spanish]. Arch Bronconeumol 2005; 41 (5) 272-289
    CrossrefPubMedGoogle Scholar
  • 12 British Thoracic Society Standards of Care Committee. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax 2001; 56 (Suppl. 04) IV1-IV64
    PubMedGoogle Scholar
  • 13 Sociedade Portuguesa de Pneumologia; Comissão de Infecciologia Respiratória. Portuguese Respiratory Society guidelines for the management of community-acquired pneumonia in immunocompetent adults [in Portuguese]. Rev Port Pneumol 2003; 9 (5) 435-461
    PubMedGoogle Scholar
  • 14 Société de Pathologie Infectieuse de Langue Francaise. Infections des voies respiratoires, Conférence de consensus en thérapeutique anti-infectieuse. Rev Méd Infect 1991; 21: 1s-8s
    PubMedGoogle Scholar
  • 15 Chidiac C ; Société de pathologie infectieuse de langue française; Agence française de sécurité sanitaire des produits de santé. Systemic antibiotherapy for the treatment of lower respiratory tract infections. Community acquired pneumonia, acute exacerbation of obstructive chronic bronchitis [in French]. Med Mal Infect 2011; 41 (5) 221-228
    CrossrefPubMedGoogle Scholar
  • 16 Strålin K, Goscinski G, Hedlund J , et al. Management of adult patients with community-acquired pneumonia. Evidence-based guidelines from the Swedish Infectious Diseases Association [in Swedish]. Lakartidningen 2008; 105 (38) 2582-2587
    PubMedGoogle Scholar
  • 17 Memish ZA, Arabi YM, Ahmed QA, Shibl AM, Niederman MS ; GCC CAP Working Group. Management and prevention strategies for community-acquired pneumonia in the Gulf Corporation Council. J Chemother 2007; 19 (Suppl. 01) 33-46
    PubMedGoogle Scholar
  • 18 Luna CM, Ramírez J, López H , et al; Grupo de trabajo de la Asociacion Latinoamericana del Tórax (ALAT). ALAT (Latin American Thoracic Association) recommendations on community-acquired pneumonia [in Spanish]. Arch Bronconeumol 2001; 37 (8) 340-348
    CrossrefPubMedGoogle Scholar
  • 19 Luna CM, Calmaggi A, Caberloto O , et al; Grupo Argentino de Estudio de la NAC. Neumonia acquired in the community. Practical guide elaborated by a committee intersocieties [in Spanish]. Medicina (B Aires) 2003; 63 (4) 319-343
    PubMedGoogle Scholar
  • 20 Saldías PF, Pérez CC. National consensus for management of community acquired pneumonia in adults [in Spanish]. Rev Chilena Infectol 2005; 22 (Suppl. 01) S7-s10
    PubMedGoogle Scholar
  • 21 Corrêa Rde A, Lundgren FL, Pereira-Silva JL , et al; Comissão de Infecções Respiratórias e Micoses - Sociedade Brasileira de Pneumologia e Tisiologia. Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009. J Bras Pneumol 2009; 35 (6) 574-601
    CrossrefPubMedGoogle Scholar
  • 22 Working Group of the South African Thoracic Society. Management of community-acquired pneumonia in adults. S Afr Med J 2007; 97: 1296-1306
    PubMedGoogle Scholar
  • 23 [(The JRS Guideline for the management of hospital-acquired pneumonia in adults)]. Nippon Naika Gakkai Zasshi 2008; 97 (10) 2578-2583
    CrossrefPubMedGoogle Scholar
  • 24 Simpson SH, Marrie TJ, Majumdar SR. Do guidelines guide pneumonia practice? A systematic review of interventions and barriers to best practice in the management of community-acquired pneumonia. Respir Care Clin N Am 2005; 11 (1) 1-13
    CrossrefPubMedGoogle Scholar
  • 25 Bodí M, Rodríguez A, Solé-Violán J , et al; Community-Acquired Pneumonia Intensive Care Units (CAPUCI) Study Investigators. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America guidelines on survival. Clin Infect Dis 2005; 41 (12) 1709-1716
    CrossrefPubMedGoogle Scholar
  • 26 Menéndez R, Ferrando D, Vallés JM, Vallterra J. Influence of deviation from guidelines on the outcome of community-acquired pneumonia. Chest 2002; 122 (2) 612-617
    CrossrefPubMedGoogle Scholar
  • 27 McCabe C, Kirchner C, Zhang H, Daley J, Fisman DN. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Ann Intern Med 2009; 169 (16) 1525-1531
    CrossrefPubMedGoogle Scholar
  • 28 Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med 1995; 333 (24) 1618-1624
    CrossrefPubMedGoogle Scholar
  • 29 Vergis EN, Yu VL. New directions for future studies of community-acquired pneumonia: optimizing impact on patient care. Eur J Clin Microbiol Infect Dis 1999; 18 (12) 847-851
    CrossrefPubMedGoogle Scholar
  • 30 Luna CM, Famiglietti A, Absi R , et al. Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina. Chest 2000; 118 (5) 1344-1354
    CrossrefPubMedGoogle Scholar
  • 31 Arnold FW, Summersgill JT, Lajoie AS , et al; Community-Acquired Pneumonia Organization (CAPO) Investigators. A worldwide perspective of atypical pathogens in community-acquired pneumonia. Am J Respir Crit Care Med 2007; 175 (10) 1086-1093
    CrossrefPubMedGoogle Scholar
  • 32 World Health Organization, Department of Health Statistics and Informatics. Estimates of Deaths by Cause for the Year 2008. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf . Accessed May 30, 2012
    PubMedGoogle Scholar
  • 33 Woodhead M, Blasi F, Ewig S , et al; Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections—full version. Clin Microbiol Infect 2011; 17 (Suppl. 06) E1-E59
    PubMedGoogle Scholar
  • 34 Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ. Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. Arch Intern Med 1999; 159 (21) 2562-2572
    CrossrefPubMedGoogle Scholar
  • 35 Mandell LA, Wunderink RG, Anzueto A , et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl. 02) S27-S72
    CrossrefPubMedGoogle Scholar
  • 36 Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R. The cost of treating community-acquired pneumonia. Clin Ther 1998; 20 (4) 820-837
    CrossrefPubMedGoogle Scholar
  • 37 American Thoracic Society. Trends in Pneumonia and Influenza Morbidity and Mortality. American Thoracic Society; 2007
    PubMedGoogle Scholar
  • 38 Niederman MS, Brito V. Pneumonia in the older patient. Clin Chest Med 2007; 28 (4) 751-771 , vi
    CrossrefPubMedGoogle Scholar
  • 39 Fine MJ, Smith MA, Carson CA , et al. Prognosis and outcomes of patients with community-acquired pneumonia: a meta-analysis. JAMA 1996; 275 (2) 134-141
    CrossrefPubMedGoogle Scholar
  • 40 Feikin DR, Schuchat A, Kolczak M , et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995–1997. Am J Public Health 2000; 90 (2) 223-229
    CrossrefPubMedGoogle Scholar
  • 41 Kaplan V, Clermont G, Griffin MF , et al. Pneumonia: still the old man's friend?. Arch Intern Med 2003; 163 (3) 317-323
    CrossrefPubMedGoogle Scholar
  • 42 Baddour LM, Yu VL, Klugman KP , et al; International Pneumococcal Study Group. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004; 170 (4) 440-444
    CrossrefPubMedGoogle Scholar
  • 43 Waterer GW, Somes GW, Wunderink RG. Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 2001; 161 (15) 1837-1842
    CrossrefPubMedGoogle Scholar
  • 44 Brown RB, Iannini P, Gross P, Kunkel M. Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest 2003; 123 (5) 1503-1511
    CrossrefPubMedGoogle Scholar
  • 45 Weiss K, Tillotson GS. The controversy of combination vs monotherapy in the treatment of hospitalized community-acquired pneumonia. Chest 2005; 128 (2) 940-946
    CrossrefPubMedGoogle Scholar
  • 46 Mufson MA, Stanek RJ. Bacteremic pneumococcal pneumonia in one American City: a 20-year longitudinal study, 1978–1997. Am J Med 1999; 107 (1A) 34S-43S
    PubMedGoogle Scholar
  • 47 Martin-Loeches I, Lisboa T, Rodriguez A , et al. Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia. Intensive Care Med 2010; 36 (4) 612-620
    CrossrefPubMedGoogle Scholar
  • 48 Houck PM, MacLehose RF, Niederman MS, Lowery JK. Empiric antibiotic therapy and mortality among Medicare pneumonia inpatients in 10 western states: 1993, 1995, and 1997. Chest 2001; 119 (5) 1420-1426
    CrossrefPubMedGoogle Scholar
  • 49 Farrell DJ, Felmingham D. The PROTEKT global study (year 4) demonstrates a continued lack of resistance development to telithromycin in Streptococcus pneumoniae. J Antimicrob Chemother 2005; 56 (4) 795-797
    CrossrefPubMedGoogle Scholar
  • 50 Clinical and Laboratory Standards Institute. . Press release. January 2008 www.clsi.org . Accessed May 30, 2012.
    PubMed
  • 51 Plouffe JF, Breiman RF, Facklam RR ; Franklin County Pneumonia Study Group. Bacteremia with Streptococcus pneumoniae. Implications for therapy and prevention. JAMA 1996; 275 (3) 194-198
    CrossrefPubMedGoogle Scholar
  • 52 Metlay JP, Hofmann J, Cetron MS , et al. Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2000; 30 (3) 520-528
    CrossrefPubMedGoogle Scholar
  • 53 Turett GS, Blum S, Fazal BA, Justman JE, Telzak EE. Penicillin resistance and other predictors of mortality in pneumococcal bacteremia in a population with high human immunodeficiency virus seroprevalence. Clin Infect Dis 1999; 29 (2) 321-327
    CrossrefPubMedGoogle Scholar
  • 54 Moroney JF, Fiore AE, Harrison LH , et al. Clinical outcomes of bacteremic pneumococcal pneumonia in the era of antibiotic resistance. Clin Infect Dis 2001; 33 (6) 797-805
    CrossrefPubMedGoogle Scholar
  • 55 Daneman N, McGeer A, Green K, Low DE ; Toronto Invasive Bacterial Diseases Network. Macrolide resistance in bacteremic pneumococcal disease: implications for patient management. Clin Infect Dis 2006; 43 (4) 432-438
    CrossrefPubMedGoogle Scholar
  • 56 Feldman RB, Rhew DC, Wong JY, Charles RA, Goetz MB ; American Thoracic Society. Azithromycin monotherapy for patients hospitalized with community-acquired pneumonia: a 31/2-year experience from a veterans affairs hospital. Arch Intern Med 2003; 163 (14) 1718-1726
    CrossrefPubMedGoogle Scholar
  • 57 Vanderkooi OG, Low DE, Green K, Powis JE, McGeer A ; Toronto Invasive Bacterial Disease Network. Predicting antimicrobial resistance in invasive pneumococcal infections. Clin Infect Dis 2005; 40 (9) 1288-1297
    CrossrefPubMedGoogle Scholar
  • 58 Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ ; Infectious Diseases Society of America. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis 2000; 31 (2) 347-382
    CrossrefPubMedGoogle Scholar
  • 59 Fine MJ, Auble TE, Yealy DM , et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336 (4) 243-250
    CrossrefPubMedGoogle Scholar
  • 60 Lim WS, van der Eerden MM, Laing R , et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58 (5) 377-382
    CrossrefPubMedGoogle Scholar
  • 61 Niederman MS, Feldman C, Richards GA. Combining information from prognostic scoring tools for CAP: an American view on how to get the best of all worlds. Eur Respir J 2006; 27 (1) 9-11
    CrossrefPubMedGoogle Scholar
  • 62 Aujesky D, Auble TE, Yealy DM , et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005; 118 (4) 384-392
    CrossrefPubMedGoogle Scholar
  • 63 Shindo Y, Sato S, Maruyama E , et al. Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia. Respirology 2008; 13 (5) 731-735
    CrossrefPubMedGoogle Scholar
  • 64 Brown SM, Jones BE, Jephson AR, Dean NC ; Infectious Disease Society of America/American Thoracic Society 2007. Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med 2009; 37 (12) 3010-3016
    CrossrefPubMedGoogle Scholar
  • 65 Metersky ML, Ma A, Bratzler DW, Houck PM. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med 2004; 169 (3) 342-347
    CrossrefPubMedGoogle Scholar
  • 66 Niederman MS, Brito V. Pneumonia in the older patient. Clin Chest Med 2007; 28 (4) 751-771 , vi
    CrossrefPubMedGoogle Scholar
  • 67 File Jr TM, Garau J, Blasi F , et al. Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia. Chest 2004; 125 (5) 1888-1901
    CrossrefPubMedGoogle Scholar
  • 68 Leroy O, Saux P, Bédos JP, Caulin E. Comparison of levofloxacin and cefotaxime combined with ofloxacin for ICU patients with community-acquired pneumonia who do not require vasopressors. Chest 2005; 128 (1) 172-183
    CrossrefPubMedGoogle Scholar
  • 69 Lodise TP, Kwa A, Cosler L, Gupta R, Smith RP. Comparison of beta-lactam and macrolide combination therapy versus fluoroquinolone monotherapy in hospitalized Veterans Affairs patients with community-acquired pneumonia. Antimicrob Agents Chemother 2007; 51 (11) 3977-3982
    CrossrefPubMedGoogle Scholar
  • 70 Lobo LJ, Reed KD, Wunderink RG. Expanded clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus pneumonia. Chest 2010; 138 (1) 130-136
    CrossrefPubMedGoogle Scholar
  • 70a Seymann GB. Community-acquired pneumonia: defining quality care. J Hosp Med 2006; 1: 344-353
    CrossrefPubMedGoogle Scholar
  • 71 Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004; 164 (6) 637-644
    CrossrefPubMedGoogle Scholar
  • 72 Wachter RM, Flanders SA, Fee C, Pronovost PJ. Public reporting of antibiotic timing in patients with pneumonia: lessons from a flawed performance measure. Ann Intern Med 2008; 149 (1) 29-32
    CrossrefPubMedGoogle Scholar
  • 73 Welker JA, Huston M, McCue JD. Antibiotic timing and errors in diagnosing pneumonia. Arch Intern Med 2008; 168 (4) 351-356
    CrossrefPubMedGoogle Scholar
  • 74 Polgreen PM, Chen YY, Cavanaugh JE , et al. An outbreak of severe Clostridium difficile-associated disease possibly related to inappropriate antimicrobial therapy for community-acquired pneumonia. Infect Control Hosp Epidemiol 2007; 28 (2) 212-214
    CrossrefPubMedGoogle Scholar
  • 75 Whitney CG, Farley MM, Hadler J , et al; Active Bacterial Core Surveillance of the Emerging Infections Program Network. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348 (18) 1737-1746
    CrossrefPubMedGoogle Scholar
  • 76 Bender JM, Ampofo K, Korgenski K , et al. Pneumococcal necrotizing pneumonia in Utah: does serotype matter?. Clin Infect Dis 2008; 46 (9) 1346-1352
    CrossrefPubMedGoogle Scholar
  • 77 Fishbane S, Niederman MS, Daly C , et al. The impact of standardized order sets and intensive clinical case management on outcomes in community-acquired pneumonia. Arch Intern Med 2007; 167 (15) 1664-1669
    CrossrefPubMedGoogle Scholar
  • 78 Woodhead M. Community-acquired pneumonia guidelines—an international comparison: a view from Europe. Chest 1998; 113 (3, Suppl) 183S-187S
    CrossrefPubMedGoogle Scholar
  • 79 Díaz A, Barria P, Niederman M , et al. Etiology of community-acquired pneumonia in hospitalized patients in Chile: the increasing prevalence of respiratory viruses among classic pathogens. Chest 2007; 131 (3) 779-787
    CrossrefPubMedGoogle Scholar