TY - JOUR
T1 - International Perspective on the New 2019 American Thoracic Society/Infectious Diseases Society of America Community-Acquired Pneumonia Guideline
T2 - A Critical Appraisal by a Global Expert Panel
AU - Pletz, Mathias W.
AU - Blasi, Francesco
AU - Chalmers, James D.
AU - Dela Cruz, Charles S.
AU - Feldman, Charles
AU - Luna, Carlos M.
AU - Ramirez, Julio A.
AU - Shindo, Yuichiro
AU - Stolz, Daiana
AU - Torres, Antoni
AU - Webb, Brandon
AU - Welte, Tobias
AU - Wunderink, Richard
AU - Aliberti, Stefano
N1 - Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. W. P. reports grants and personal fees from Pfizer, MSD, Novartis, Bayer, Roche, Angelini, Thermo Fisher, and Becton Dickinson. C. F. has received speaker fees from Pfizer, MSD (Merck), and AstraZeneca; advisory board fees from Pfizer and P&G South Africa; and holds a research grant from Pfizer. F. B. reports grants and personal fees from AstraZeneca, grants from Bayer, grants and personal fees from Chiesi, grants and personal fees from GlaxoSmithKline (GSK), personal fees from Guidotti, personal fees from Grifols, grants and personal fees from Insmed, personal fees from Menarini, personal fees from Mundipharma, personal fees from Novartis, grants and personal fees from Pfizer, and personal fees from Zambon, outside the submitted work. J. D. C. has received speaker fees from AstraZeneca, Boehringer Ingelheim, GSK, and Insmed; consultancy fees for AstraZeneca, Boehringer Ingelheim, GSK, Grifols, Insmed, and Zambon; and holds research grants from AstraZeneca, Boehringer Ingelheim, GSK, Gilead Sciences Grifols, and Novartis. D. S. has received research grants from the Swiss National Foundation, AstraZeneca AG, Pan Gas AG, Weinmann AG, Curetis AG, Boston Scientific AG, Circassia Pharmaceuticals, and Lungenliga Switzerland; received payment for lectures, advisory panels, or sponsorship to attend scientific meetings from Novartis AG, AstraZeneca AG, GSK AG, Roche AG, Zambon, Pfizer, and Schwabe Pharma AG. D. S. is the current education council chair of the European Respiratory Society and immediate past president of the European Board of Accreditation in Pneumology, and is the current GOLD representative for Switzerland. A.T. is speaker for Pfizer, Basilea, and MSD. B. W. has received a speaker’s honorarium from BioFire (BioMérieux). T. W. reported personal fees from GSK, MSD, Pfizer, Roche, and Sanofi outside the submitted work. S. A. reports personal fees from Bayer Healthcare, personal fees from Grifols, personal fees from AstraZeneca, personal fees from Zambon, grants and personal fees from Chiesi, grants and personal fees from Insmed, personal fees from GSK, personal fees from Menarini, personal fees from ZetaCube Srl, and grants from Fisher & Paykel, outside the submitted work. None declared (C. S. D. C., C. M. L., J. A. R., Y. S., R. W.).
Publisher Copyright:
© 2020 American College of Chest Physicians
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - In 2019, the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) issued a substantial revision of the 2007 guideline on community-acquired pneumonia (CAP). Despite the fact that generalization of infectious disease guidelines is limited because of substantial geographic differences in microbiologic etiology and antimicrobial resistance, the ATS/IDSA guideline is frequently applied outside the United States. Therefore, this project aimed to give a perspective on the ATS/IDSA CAP recommendations related to the management of CAP outside the United States. For this, an expert panel composed of 14 international key opinion leaders in the field of CAP from 10 countries across five continents, who were not involved in producing the 2019 guideline, was asked to subjectively name the five most useful changes, the recommendation viewed most critically, and the recommendation that cannot be applied to their respective region. There was no formal consensus process, and the article reflects different opinions. Recommendations welcomed by most of the international pneumonia experts included the abandonment of the concept of “health-care-associated pneumonia,” the more restrictive indication for empiric macrolide treatment in outpatients, the increased emphasis on microbiologic diagnostics, and addressing the use of corticosteroids. Main criticisms included the somewhat arbitrary choice of a 25% resistance threshold for outpatient macrolide monotherapy. Experts from areas with elevated mycobacterial prevalence particularly opposed the recommendation of fluoroquinolones, even as an alternative.
AB - In 2019, the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) issued a substantial revision of the 2007 guideline on community-acquired pneumonia (CAP). Despite the fact that generalization of infectious disease guidelines is limited because of substantial geographic differences in microbiologic etiology and antimicrobial resistance, the ATS/IDSA guideline is frequently applied outside the United States. Therefore, this project aimed to give a perspective on the ATS/IDSA CAP recommendations related to the management of CAP outside the United States. For this, an expert panel composed of 14 international key opinion leaders in the field of CAP from 10 countries across five continents, who were not involved in producing the 2019 guideline, was asked to subjectively name the five most useful changes, the recommendation viewed most critically, and the recommendation that cannot be applied to their respective region. There was no formal consensus process, and the article reflects different opinions. Recommendations welcomed by most of the international pneumonia experts included the abandonment of the concept of “health-care-associated pneumonia,” the more restrictive indication for empiric macrolide treatment in outpatients, the increased emphasis on microbiologic diagnostics, and addressing the use of corticosteroids. Main criticisms included the somewhat arbitrary choice of a 25% resistance threshold for outpatient macrolide monotherapy. Experts from areas with elevated mycobacterial prevalence particularly opposed the recommendation of fluoroquinolones, even as an alternative.
KW - antibiotic resistance
KW - corticosteroids
KW - guideline
KW - health-care-associated pneumonia
KW - macrolide
UR - http://www.scopus.com/inward/record.url?scp=85093982032&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85093982032&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.07.089
DO - 10.1016/j.chest.2020.07.089
M3 - Review article
C2 - 32858009
AN - SCOPUS:85093982032
VL - 158
SP - 1912
EP - 1918
JO - Chest
JF - Chest
SN - 0012-3692
IS - 5
ER -