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
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, Dimitry
AU - Restrepo, Marcos
AU - Rigau, David
AU - Schultz, Marcus
AU - Weiss, Emmanuele
AU - Welte, Tobias
AU - Wunderink, Richard
N1 - Funding Information:
We would like to thank Kellee Kaulback, the information specialist from McMaster University, for undertaking the literature searches. This document was endorsed by the ERS executive committee on 16 January 2023, ALAT on 11 January 2023, ESCMID on 15 December 2022 and ESICM on 19 January 2023. The guidelines published by the European Respiratory Society (ERS) incorporate data obtained from a comprehensive and systematic literature review of the most recent studies available at the time. Health professionals are encouraged to take the guidelines into account in their clinical practice. However, the recommendations issued by this guideline may not be appropriate for use in all situations. It is the individual responsibility of health professionals to consult other sources of relevant information, to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and the patient's caregiver where appropriate and/or necessary, and to verify rules and regulations applicable to drugs and devices at the time of prescription.
Funding Information:
Support statement: This work was supported by the European Society of Intensive Care Medicine and the European Respiratory Society. Funding information for this article has been deposited with the Crossref Funder Registry.
Publisher Copyright:
© 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
PY - 2023/6
Y1 - 2023/6
N2 - Purpose: Severe community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and whilst European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP. Methods: 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 - Purpose: Severe community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and whilst European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP. Methods: 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 - https://www.scopus.com/pages/publications/85151405202
U2 - 10.1007/s00134-023-07033-8
DO - 10.1007/s00134-023-07033-8
M3 - Article
C2 - 37012484
SN - 0342-4642
VL - 49
SP - 615
EP - 632
JO - Intensive care medicine
JF - Intensive care medicine
IS - 6
ER -
SDG 3 Good Health and Well-being
SDG 10 Reduced Inequalities