Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review

Author:

Candel Francisco Javier1ORCID,Salavert Miguel2ORCID,Basaras Miren3ORCID,Borges Marcio45,Cantón Rafael67ORCID,Cercenado Emilia8ORCID,Cilloniz Catian910ORCID,Estella Ángel11ORCID,García-Lechuz Juan M.12ORCID,Garnacho Montero José13ORCID,Gordo Federico14,Julián-Jiménez Agustín15ORCID,Martín-Sánchez Francisco Javier16,Maseda Emilio17ORCID,Matesanz Mayra18,Menéndez Rosario19,Mirón-Rubio Manuel20ORCID,Ortiz de Lejarazu Raúl21ORCID,Polverino Eva222324,Retamar-Gentil Pilar725,Ruiz-Iturriaga Luis Alberto2627ORCID,Sancho Susana28,Serrano Leyre2627ORCID

Affiliation:

1. Clinical Microbiology & Infectious Diseases, Transplant Coordination, IdISSC & IML Health Research Institutes, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain

2. Infectious Diseases Unit, La Fe (IIS) Health Research Institute, University Hospital La Fe, 46015 Valencia, Spain

3. Immunology, Microbiology and Parasitology Department, Faculty of Medicine and Nursing, University of País Vasco, 48940 Bizkaia, Spain

4. Multidisciplinary Sepsis Unit, Intensive Medicine Department, University Hospital Son Llàtzer, 07198 Palma de Mallorca, Spain

5. Instituto de Investigación Sanitaria Islas Baleares (IDISBA), 07198 Mallorca, Spain

6. Clinical Microbiology Service, University Hospital Ramón y Cajal, Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain

7. CIBER of Infectious Diseases (CIBERINFEC), National Institute of Health San Carlos III, 28034 Madrid, Spain

8. Clinical Microbiology & Infectious Diseases Service, University Hospital Gregorio Marañón, 28009 Madrid, Spain

9. IDIBAPS, CIBERES, 08007 Barcelona, Spain

10. Faculty of Health Sciences, Continental University, Huancayo 15304, Peru

11. Intensive Care Unit, INIBiCA, University Hospital of Jerez, Medicine Department, University of Cádiz, 11404 Jerez, Spain

12. Clinical Microbiology, University Hospital Miguel Servet, 50009 Zaragoza, Spain

13. Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, 41013 Sevilla, Spain

14. Intensive Medicine Department, University Hospital of Henares, 28802 Madrid, Spain

15. Emergency Department, University Hospital Toledo, University of Castilla La Mancha, 45007 Toledo, Spain

16. Emergency Department, Clinical University Hospital San Carlos, 28040 Madrid, Spain

17. Anesthesiology Department, Hospital Quirón Salud Valle del Henares, 28850 Madrid, Spain

18. Hospital at Home Unit, Clinic University Hospital San Carlos, 28040 Madrid, Spain

19. Pneumology Service, La Fe (IIS) Health Research Institute, University Hospital La Fe, 46015 Valencia, Spain

20. Hospital at Home Service, University of Torrejón, Torrejón de Ardoz, 28006 Madrid, Spain

21. National Influenza Center, Clinic University Hospital of Valladolid, University of Valladolid, 47003 Valladolid, Spain

22. Pneumology Service, Hospital Vall d’Hebron, 08035 Barcelona, Spain

23. Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain

24. CIBER of Respiratory Diseases (CIBERES), Institute of Health San Carlos III, 28029 Madrid, Spain

25. Infectious Diseases & Microbiology Clinical Management Unit, University Hospital Virgen Macarena, IBIS, University of Seville, 41013 Sevilla, Spain

26. Pneumology Service, University Hospital Cruces, 48903 Barakaldo, Spain

27. Faculty of Medicine and Nursing, University of País Vasco, 48940 Bizkaia, Spain

28. Intensive Medicine Department, University Hospital La Fe, 46015 Valencia, Spain

Abstract

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed.

Publisher

MDPI AG

Subject

General Medicine

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