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. 2023 Jun;49(6):615-632.
doi: 10.1007/s00134-023-07033-8. Epub 2023 Apr 4.

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

Ignacio Martin-Loeches #  1   2   3   4 , Antoni Torres #  5   6 , Blin Nagavci  7 , Stefano Aliberti  8   9 , Massimo Antonelli  10 , Matteo Bassetti  11 , Lieuwe D Bos  12 , James D Chalmers  13 , Lennie Derde  14 , Jan de Waele  15 , Jose Garnacho-Montero  16 , Marin Kollef  17 , Carlos M Luna  18 , Rosario Menendez  19 , Michael S Niederman  19 , Dmitry Ponomarev  20   21 , Marcos I Restrepo  22 , David Rigau  23 , Marcus J Schultz  12   24   25 , Emmanuel Weiss  26 , Tobias Welte  27 , Richard Wunderink  28
Affiliations

ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

Ignacio Martin-Loeches et al. Intensive Care Med. 2023 Jun.

Erratum in

  • Correction: ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia.
    Martin-Loeches I, Torres A, Nagavci B, Aliberti S, Antonelli M, Bassetti M, Bos LD, Chalmers JD, Derde L, De Waele J, Garnacho-Montero J, Kollef M, Luna CM, Menendez R, Niederman MS, Ponomarev D, Restrepo MI, Rigau D, Schultz MJ, Weiss E, Welte T, Wunderink R. Martin-Loeches I, et al. Intensive Care Med. 2023 Aug;49(8):1040-1041. doi: 10.1007/s00134-023-07082-z. Intensive Care Med. 2023. PMID: 37195462 Free PMC article. No abstract available.

Abstract

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.

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Conflict of interest statement

IML reports grants from GE, consulting fees from Gilead and MSD, lecture honoraria from MSD, Gilead and Mundipharma, and advisory board and lectures for Pfizer, MSD and Menarini, outside the submitted work. AT reports consulting fees and lecture honoraria from Pfizer, Poliphor, MSD, Jansen and OM Pharma, and advisory board and lectures for Pfizer, MSD, Atriva, Jansen and Menarini, outside the submitted work. BN serves as the ERS methodologist. SA reports grants from Insmed Incorporated, Chiesi, and Fisher & Paykel, royalties from McGraw Hill, consulting fees from Insmed Incorporated, Insmed Italy, Insmed Ireland Ltd, Zambon, AstraZeneca UK Limited, CSL Behring GmbH, Grifols, Fondazione Charta, Boehringer Ingelheim, Chiesi, Zcube Srl, Menarini and MSD Italia Srl, lecture honoraria from GlaxoSmithKline Spa, and advisory board participation with Insmed Incorporated, Insmed Italy, AstraZeneca UK Limited and MSD Italia Srl, outside the submitted work. MA reports grants from GE, consulting fees from Gilead, lecture honoraria from MSD, Chiesi, Fisher & Pickel, and Orphan, and a leadership role at ESICM, outside the submitted work. MB reports research grants and/or advisor/consultant and/or speaker/chairman for Bayer, Biomerieux, Cidara, Cipla, Gilead, Menarini, MSD, Pfizer, Shionogi and Thermo-Fisher, outside the submitted work. LB reports grants from the Dutch Lung Foundation (young investigator grant), the Dutch Lung Foundation and Health Holland (public–private partnership grant), Dutch Lung Foundation (Dirkje Postma Award), IMI COVID-19 initiative and Amsterdam UMC fellowship, outside the submitted work. JC reports research grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences, Grifols, Novartis and Insmed, and received consultancy or speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Janssen, Novartis, Pfizer and Zambon, outside the submitted work, and is chief editor of the ERJ. LD reports grants from European Union's FP7 grant PREPARE (602525); EU FP7-HEALTH-2013-INNOVATION-1, grant number 602525, H2020 RECOVER grant agreement number 101003589, ZonMw grant ANAkinra voor de behandeling van CORonavirus infectious disease 2019 op de Intensive Care (ANACOR-IC) project number 10150062010003, lecture honoraria from Netherlands International Sepsis Symposium, travel support from ESICM, ISICEM, Weimar sepsis Update, European Respiratory Society, Critical Care Reviews, UPMC Pittsburgh, International Sepsis Forum and ANZICS/ACCCN ASM, and advisory board participation with Sepsis Canada International; REMAP-CAP has received drugs as part of the trial interventions; and the following leadership positions: chair, international trial steering committee, REMAP-CAP (2021–present), coordinating committee member, ECRAID (2021–present), member expert panel on COVID-19 therapeutics, European Commission (2021–present), member “Pandemic Preparedness Plan” committee, KNAW (2021–present), chair elect Education and Training Committee (2019–2021), chair Clinical Training Committee, ESICM (2019–2021), task force infectious threats, NVIC (chair 2019–2021), outside the submitted work. JdW reports grants from Flanders Research Foundation and consulting fees from Pfizer and MSD, outside the submitted work. MK reports consulting fees from Merck, Pfizer and Shionogi, outside the submitted work. CL reports grants as principal investigator in clinical trials, has participated on adjudication committee for diagnosis in clinical trials, has received honoraria for lectures on pulmonary infections, has received economical support for attending to the ERS and ATS meetings, and has participated on an advisory board for pneumococcal vaccines, outside the submitted work. RM reports lecture honoraria from, and participated on advisory boards for Pfizer, Advanz Pharma, Gilead Sciences and GSK, and travel support from Pfizer, Gilead and Advanz Pharma, outside the submitted work. MN reports grants from Shionogi, Merck and Bayer, consulting fees from Pfizer, Merck, Shionogi, Bayer, Nabriva and Thermo-Fisher, and participation on an advisory board for Fab'entec, outside the submitted work. DR formerly served as ERS methodologist. MS received grants from Zonmw (Netherlands Organisation For Health Research And Development) and financial support from Hamilton Medical AG, Switzerland, outside of this project. EW reports speaker and travel fees from MSD, Akcea Therapeutics and LFB, outside the submitted work. TW reports grants from German Ministry of Research and Education, lecture honoraria from Advanz, Biotest, Thermo Fischer, MSD, Pfizer and Shionogi, outside the submitted work. RW reports consultancy and lectures for bioMerieux, and consultancy for MSD, Shionogi, LaJolla, Venatorx, Vir and Microbiotx, and has acted as chairman, clinical evaluation committee for Pfizer, and as DSMB member for Vir, outside the submitted work. All other authors have nothing to disclose.

Comment in

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