Community-acquired pneumonia in adults: Etiology, diagnosis, severity assessment and treatment
DOI:
https://doi.org/10.5281/zenodo.22134704Keywords:
pneumonia, community-acquired infections, Streptococcus pneumoniae, anti-bacterial agents, severity of illness index, pneumococcal vaccinesAbstract
Introduction: Community-acquired pneumonia is a leading infectious cause of hospitalization and death in adults, with a burden that rises with age and comorbidity. The aim was to synthesize evidence on etiology, diagnosis, severity assessment, treatment and prevention of community-acquired pneumonia in immunocompetent adults. Materials and methods: Non-systematic PubMed search of clinical practice guidelines, reviews and original studies published up to 2023, preferring sources of higher methodological quality and clinical relevance. Results: Diagnosis rests on a compatible clinical picture and an infiltrate on imaging. Molecular methods have increased pathogen detection—especially respiratory viruses—without displacing Streptococcus pneumoniae as the most frequent bacterium. CURB-65 and the pneumonia severity index, together with American Thoracic Society and Infectious Diseases Society of America criteria, guide the care setting. Empirical treatment is stratified by severity and resistance risk; on the ward, beta-lactam monotherapy has not been shown to be inferior to combination regimens. Corticosteroids benefit severe pneumonia and treatment duration should be guided by clinical stability. Conclusions: Pneumococcal and influenza vaccination, together with smoking cessation, are the main preventive measures.References
Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. Lancet. 2021;398(10303):906-19. https://doi.org/10.1016/S0140-6736(21)00630-9
Ramirez JA, Wiemken TL, Peyrani P, Arnold FW, Kelley R, Mattingly WA, et al. Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality. Clin Infect Dis. 2017;65(11):1806-12. https://doi.org/10.1093/cid/cix647
Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-27. https://doi.org/10.1056/NEJMoa1500245
Torres A, Cilloniz C, Niederman MS, Menéndez R, Chalmers JD, Wunderink RG, et al. Pneumonia. Nat Rev Dis Primers. 2021;7(1):25. https://doi.org/10.1038/s41572-021-00259-0
Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015;386(9998):1097-108. https://doi.org/10.1016/S0140-6736(15)60733-4
Cilloniz C, Liapikou A, Torres A. Advances in molecular diagnostic tests for pneumonia. Curr Opin Pulm Med. 2020;26(3):241-8. https://doi.org/10.1097/MCP.0000000000000668
Villafuerte D, Aliberti S, Soni NJ, Faverio P, Marcos PJ, Wunderink RG, et al. Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia. Respirology. 2020;25(5):543-51. https://doi.org/10.1111/resp.13663
Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA. 1997;278(17):1440-5. DOI no disponible.
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-67. https://doi.org/10.1164/rccm.201908-1581ST
Claessens YE, Debray MP, Tubach F, Brun AL, Rammaert B, Hausfater P, et al. Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community-acquired pneumonia. Am J Respir Crit Care Med. 2015;192(8):974-82. https://doi.org/10.1164/rccm.201501-0017OC
Huang DT, Yealy DM, Filbin MR, Brown AM, Chang CH, Doi Y, et al. Procalcitonin-guided use of antibiotics for lower respiratory tract infection. N Engl J Med. 2018;379(3):236-49. https://doi.org/10.1056/NEJMoa1802670
Niederman MS, Torres A. Severe community-acquired pneumonia. Eur Respir Rev. 2022;31(166):220123. https://doi.org/10.1183/16000617.0123-2022
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-82. https://doi.org/10.1136/thorax.58.5.377
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-50. https://doi.org/10.1056/NEJM199701233360402
Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther. 2021;217:107663. https://doi.org/10.1016/j.pharmthera.2020.107663
Postma DF, van Werkhoven CH, van Elden LJ, Thijsen SF, Hoepelman AI, Kluytmans JA, et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015;372(14):1312-23. https://doi.org/10.1056/NEJMoa1406330
Torres A, Sibila O, Ferrer M, Polverino E, Menéndez R, Mensa J, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313(7):677-86. https://doi.org/10.1001/jama.2015.88
Dequin PF, Meziani F, Quenot JP, Kamel T, Ricard JD, Badie J, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med. 2023;388(21):1931-41. https://doi.org/10.1056/NEJMoa2215145
Uranga A, España PP, Bilbao A, Quintana JM, Arriaga I, Intxausti M, et al. Duration of antibiotic treatment in community-acquired pneumonia: a multicenter randomized clinical trial. JAMA Intern Med. 2016;176(9):1257-65. https://doi.org/10.1001/jamainternmed.2016.3633
Bonten MJM, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372(12):1114-25. https://doi.org/10.1056/NEJMoa1408544
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Copyright (c) 2023 Andréa Silva de Souza, Eduardo José Bueno Marques, Ramón Mario Bellón Préstamo (Autor/a)
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