Severe Community Acquired Pneumonia

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Severe Community-Acquired Pneumonia

Rapid Microbiological Techniques
Should rapid microbiological techniques be added to current testing of blood and respiratory tract samples?
Recommendation: If the technology is available, send a lower respiratory tract sample (sputum or endotracheal aspirates) for multiplex PCR testing (virus and/or bacterial detection) when non-standard sCAP antibiotics are prescribed or considered.

High-Flow Nasal Oxygen (HFNO)
Can either non-invasive ventilation (NIV) or high-flow nasal oxygen (HFNO) be used initially—rather than supplemental standard oxygen administration—to avoid intubation and reduce mortality?
Recommendation: Use high-flow nasal oxygen (HFNO) instead of standard oxygen in patients with acute hypoxemic respiratory failure not needing immediate intubation.

Non-Invasive Ventilation (NIV)
Can either non-invasive ventilation (NIV) or high-flow nasal oxygen (HFNO) be used initially—rather than supplemental standard oxygen administration—to avoid intubation and reduce mortality?
Recommendation: Non-invasive ventilation (NIV) might be an option in certain patients with persistent hypoxemic respiratory failure not needing immediate intubation, irrespective of HFNO use.

Combination Therapy for sCAP
Should a macrolide or fluoroquinolone be used as part of combination therapy to reduce mortality and adverse clinical outcomes?
Recommendation: Add macrolides, not fluoroquinolones, to beta-lactams as empirical antibiotic therapy for hospitalized sCAP patients.

Procalcitonin (PCT) Guidance
Can serum procalcitonin (PCT) be used to reduce the duration of antibiotic therapy and improve other outcomes in comparison to standard care not guided by serial biomarker measurements?
Recommendation: Use procalcitonin (PCT) to reduce the duration of antibiotic treatment in sCAP patients.

Role of Oseltamivir in sCAP
Should oseltamivir be added to standard therapy in patients with severe community-acquired pneumonia (sCAP) and confirmed influenza?
Recommendation: Use oseltamivir for sCAP patients with influenza confirmed by PCR. If PCR is unavailable, consider empirical oseltamivir during influenza season.

Corticosteroid Use in sCAP
Does the addition of steroids to antibiotic therapy in specific severe community-acquired pneumonia (sCAP) populations lead to better outcomes in comparison to when steroid therapy is not used?
Recommendation: Use corticosteroids in sCAP patients with shock.

Prediction Scores for Drug-Resistant Pathogens
Does the use of a prediction score for drug-resistant pathogens lead to more appropriate therapy and improved outcomes (mortality, treatment failure, duration of antibiotic therapy, prolonged ICU stay)?
Recommendation: Integrate specific risk factors, based on local epidemiology and previous colonization, into clinical scores to guide therapy decisions for drug-resistant pathogens in sCAP patients.

Therapy for Aspiration Risk Factors
Do patients with severe community-acquired pneumonia (sCAP) and aspiration risk factors have better outcomes if treated with a risk-based therapy regimen instead of standard sCAP antibiotics?
Recommendation: Use a standard CAP therapy regimen and avoid specific therapy targeting anaerobic bacteria for sCAP patients with aspiration risk factors.