Diagnosis and Treatment of Adults With Community-Acquired Pneumonia (2020/02/06)

Summary of the Clinical Problem

CAP is an infection of the pulmonary parenchyma acquired outside of a health care setting. CAP is common, with more than 1.5 million adults hospitalized annually, and is the most common infectious cause of death in the US.1

CAP is a heterogeneous illness, both in illness severity and pathogens. The most common bacterial pathogens are Streptococcus pneumoniaeHaemophilus influenzaeMycoplasma pneumoniaeS aureusLegionella species, Chlamydia pneumoniae, and Moraxella catarrhalis. However, the microbiologic etiology of CAP is evolving, with increasing recognition of the role of viral pathogens using molecular detection methods.

Characteristics of the Guideline Source

The guideline was developed by the ATS and IDSA.2 They convened a 15-member panel of pulmonologists, infectious disease specialists, general internists, and methodologists with expertise in evidence synthesis. Members disclosed all potential conflicts of interest. The guideline is presented as a series of clinical questions, using the Patient or Population, Intervention, Comparison, Outcome (PICO) framework. Given the broad scope of the topic, the guideline was intentionally narrowed to cover clinical decisions from the time of diagnosis of pneumonia through treatment and follow-up imaging. It does not address initial diagnosis or prevention.

Evidence Base

For most topics, 2 methodologists conducted a systematic review, performed evidence synthesis, and prepared evidence summaries following the GRADE approach. For each question addressed by the methodologists, MEDLINE was searched for relevant literature, with meta-analysis performed when possible to obtain estimates of effects on each outcome of interest.

Author: Gregory Olson, Andrew M Davis

Link: https://jamanetwork.com/journals/jama/fullarticle/2760882