CHEST Guidelines-International-Perspective-on-the-New-2019-American

International-Perspective-on-the-New-2019-American

Pdf Summary

In 2019, the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) substantially revised their guidelines on community-acquired pneumonia (CAP), originally issued in 2007. Recognizing the global diversity in microbial etiology and antimicrobial resistance, an international panel of experts from 10 countries reviewed the applicability of these guidelines beyond the United States. They highlighted key changes, such as the discontinuation of the "health-care-associated pneumonia" category, more restrictive use of empiric macrolide treatment in outpatients, emphasis on microbiologic diagnostics, and cautious use of corticosteroids.<br /><br />The panel appreciated these updates, noting the abandonment of the healthcare-associated pneumonia category, previously linked with broad empirical antibiotic use and overtreatment of patients, as a positive step. Additionally, the guideline's stance against routine corticosteroid use and conditional recommendation of macrolide monotherapy based on resistance levels were acknowledged.<br /><br />Criticisms focused on what some experts saw as arbitrary thresholds for macrolide resistance in CAP treatment and concerns over fluoroquinolone use in regions with high mycobacterial prevalence. Given the rapid evolution of microorganisms and regional variance in pathogen prevalence, the guidelines' potential limitation in some geographical contexts was noted. Experts emphasized the importance of local epidemiological data to tailor treatment recommendations effectively.<br /><br />Overall, while the guidelines offered several beneficial updates, the report underscored the need for tailored applications of these recommendations, particularly in varied global contexts with specific epidemiological challenges, pointing out gaps in addressing immunocompromised patient needs and advocating for more regional-specific guidelines.

Keywords

American Thoracic Society

Infectious Diseases Society of America

community-acquired pneumonia

microbial etiology

antimicrobial resistance

empiric macrolide treatment

corticosteroids

macrolide resistance

fluoroquinolone use

regional epidemiological data