Management of patients with community-acquired pneumonia in outpatient settings


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Pneumonia remains a serious public health problem due to unacceptably high morbidity and mortality. Among the issues that need to be addressed, one should first of all include difficulties in establishing the initial clinical diagnosis of pneumonia, stratification of the risk of an unfavorable outcome of the disease, optimization of the choice of empirical antibiotic therapy, the relative shortage of new antibiotics, and the importance of knowing the local characteristics of the microbiological sensitivity of pneumotropic microorganisms. The article discusses the problem of managing adult patients with community-acquired pneumonia (CAP). Information on the epidemiology, diagnosis, stratification of CAP patients according to the risk of an unfavorable outcome of the disease is presented in order to determine patients of this category who could receive outpatient treatment without compromising the ultimate efficacy and safety, as well as antibacterial therapy of CAP patients in outpatient settings, including with the use of new antibiotics.

Full Text

Restricted Access

About the authors

A. I Sinopalnikov

Russian Medical Academy of Continuous Professional Education

Email: aisyn@list.ru
Dr. Sci. (Med.), Professor, Head of the Department of Pulmonology 2/1, build. 1, Barrikadnaya str., Moscow 125993, Russian Federation

References

  1. Niederman M.S., Bass J.B. Jr., Campbell G.D., et al. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Am Rev Respir Dis. 1993;148:1418-26.
  2. Pasteur L. Note on the new disease caused by the saliva of a child who died of rabies. C R Acad Sci. 1881;92:159-65. doi: 10.1016/S2352-3018(15)00108-3.
  3. Sternberg G.M. The pneumonia-coccus of Friedlander (Micrococcus Pasteuri, Sternberg). Am J Med Sci. 1885;90:106-23.
  4. Fraenkel A. Weitere Beitrage zur Lehre von den Mikrococcen der genuinen fibrinosen Pneumonie [Further contributions to the theory of Micrococci of genuine fibrinous pneumonia]. Zeitschrift filr Klinische Medicin. 1886b;i1:437-58.
  5. Osler W. The principles and practice of medicine. New York: D. Appleton and Company; 1901.
  6. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death 2013 a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117-71. doi: 10.1016/S0140-6736(14)61682-2.
  7. Metlay J.P, Waterer G.W., bang A.C., 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:e45-e67. doi: 10.1016/S0140-6736(14)61682-2.
  8. Zweigner J, Meyer E., Gastmeier P, Schwab F. Rate of antibiotic prescriptions in German outpatient care - are the guidelines followed or are they still exceeded? GMS Hyg. infect Control. 2018;13:Doc04. doi: 10.3205/dgkh000310.
  9. Socie'te' Francaise de Me'decine Ge'ne'rale. Observatoire de la Me'decine Ge'ne'ral. Donnees en consultation pour: Pneumophatie Aigue. URL: http:// omg.sfmg.org/content/donnees/donnees.php. (Accessed 28 October 2018).
  10. Lim W.S., Baudouin S.V., George R.C., et al., Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community-acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl. 3);iii1-55.
  11. Almirall J., Serra-Prat M., Bolibar i., Balasso V. Risk factors for community-acquired pneumonia in adults: a systematic review of observational studies. Respir. 2017;94:299-311. doi: 10.1159/000479089.
  12. Liapikou A., Cilloniz C., Torres A. Drugs that increase the risk of community-acquired pneumonia: a narrative review. Expert Opin Drug Saf. 2018;17:991-1003. doi: 10.1080/14740338.2018.1519545.
  13. Trotter C.L., Stuart J.M., George G., et al. increasing hospital admissions for pneumonia, England. Emerg infect Dis. 2008;14:727-33. Doi: 10.3201/ eid1405.071011.
  14. Almirall J., Bolibar i., Vidal J., et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir. J 2000;15:757-63. doi: 10.1034/j.1399-3003.2000.15d21.x.
  15. Fine M.J., Auble T.E., Yealy D.M., et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243-50. doi: 10.1056/NEJM199701233360402.
  16. Lim W.S., van der Eerden M.M., Laing R., et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377-82. doi: 10.1136/thorax.58.5.377.
  17. Raut M., Schein J., Mody S., et al. Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US. Curr Med Res Opin. 2009;25:2151-57. doi: 10.1185/03007990903102743.
  18. Van Vugt S.F, Broekhuizen B.D., Lammens C., et al. Use of serum C-reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. BMJ. 2013;346:f2450. doi: 10.1136/bmj.f2450.
  19. Smith S.M., Fahey T., Smucny J., Becker L.A. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;3:CD000245. doi: 10.1002/14651858. CD000245.pub3.
  20. Schuetz P, Muller B., Christ-Crain M., et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2012;9:CD007498. doi: 10.1002/14651858.CD007498.pub2.
  21. Ranzani O.T., Taniguchi L.U., Torres A. Severity scoring systems for pneumonia: current understanding and next steps. Curr Opin Pulm Med. 2018;24:227-36. doi: 10.1097/MCP0000000000000468.
  22. Fine M.J., Auble T.E., Yealy D.M., et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243-50. doi: 10.1056/NEJM199701233360402.
  23. Mandell L.A., Wunderink R.G., Anzueto A., et al. infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin infect Dis. 2007;44(Suppl. 2):27-72.
  24. Charles P.G., Wolfe R., Whitby M., et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin infect Dis. 2008;47:375-84. doi: 10.1086/589754.
  25. Espana P.P, Capelastegui A., Gorordo i., et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med. 2006;174:1249-56. doi: 10.1164/rccm.200602-177OC.
  26. Singer M., Deutschman C.S., Seymour C.W., et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801-10. doi: 10.1001/jama.2016.0287.
  27. Chalmers J.D., Singanayagam A., Akram A.R., et al. Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax. 2010;65:878-83. doi: 10.1136/ thx.2009.133280.
  28. Bauer T.T, Ewig S., Marre R., Suttorp N., Welte T: CRB-65 predicts death from community-acquired pneumonia. J intern Med. 2006;260:93-101. doi: 10.1111/j.1365-2796.2006.01657.x.
  29. Kaysin A, Viera A.J. Community-acquired pneumonia: diagnosis and management. Am Fam Physician. 2016;94:698-706.
  30. Corrales-Medina V.F, Musher D.M., Wells G.A., et al. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation. 2012;125:773-81. Doi: 10.1161/ CiRCUiATiONAHA.111.040766.
  31. Ewig S, Bauer T, Richter K., et al. Prediction of in-hospital death from community-acquired pneumonia by varying CRB-age groups. Eur Respir J. 2013;41:917-22. doi: 10.1183/09031936.00065212.
  32. Choudhury G, Chalmers J.D., Mandal P, et al. Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients. Eur Respir J. 2011;38:643-48. doi: 10.1183/09031936.00172910.
  33. Kolditz M, Ewig S., Schutte H., et al. Assessment of o xyg enation and comorbidities improves outcome prediction in patients with community-acquired pneumonia with a low CRB-65 score. J intern Med. 2015;278:193-202.
  34. Ewig S, Hoffken G., Kern W.V., et al. Management of adult community-acquired pneumonia and prevention - update 2016. Pneumologie. 2016;70:151-200. doi: 10.1055/s-0042-101873.
  35. Kolditz M., Braeken D., Ewig S., Rohde G. Severity assessment and the immediate and long-term prognosis in community-acquired pneumonia. Semin Respir Crit Care Med. 2016;37:886-96. doi: 10.1055/s-0036-1592127.
  36. Kolditz M., Ewig S. Community-acquired pneumonia in adults. Dtsch Arztebl int. 2017;114:838-48. doi: 10.3238/arztebl.2017.0838.
  37. Musher D.M., Thorner A.R. Community-acquired pneumonia. N Engl J Med. 2014;371:1619-28. doi: 10.1056/NEJMra1312885.
  38. Mandell L.A, Wunderink R.G., Anzueto A., et al. infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin infectDis. 2007;44(Suppl. 2):27-72.
  39. Козлов Р.С., Зырянов С.К., Синопальников А.И. и др. Резолюция совета экспертов «Эмпирическая антибактериальная терапия инфекций дыхательных путей с учетом факторов риска резистентной флоры» (28.10.2017, Москва). Справочник поликлинического врача. 2018;1:6-10.
  40. NiCE. National institute for Health and Care Excellence. Clinical Guideline [CG191]. Pneumonia in adults: diagnosis and management. Published: 3 December 2014. nice.org.uk/guidance/cg191.
  41. Cao B., Huang Y, She D.Y., et al. Diagnosis and treatment of communityacquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. Clin Respir J. 2018;12:1320-60.
  42. Boyles T.H., Brink A., Calligaro G.L., et al. South African Thoracic Society; Federation of infectious Diseases Societies of Southern Africa. South African guideline for the management of community-acquired pneumonia in adults. J Thorac Dis. 2017;9:1469-502. doi: 10.21037/jtd.2017.05.31.
  43. Correa R.A., Costa N.A., Lundgren F., et al. 2018 recommendations for the management of community acquired pneumonia. J Brasil Pneumol. 2018;44:405. doi: 10.1590/S1806-37562018000000130.
  44. Zaroff J.G., Craig T.C., Palmetto N., et al. Association of azithromycin use with cardiovascular mortality. JAMA. Network Open. 2020;3(6):e208199. doi: 10.1001/ jamanetworkopen.2020.8199.
  45. Иванчик Н.В., Чагарян А.Н., Сухорукова М.В. и др. Антибиотикорезистентность клинических штаммов Streptococcus pneumoniae в России: результаты многоцентрового эпидемиологического исследования «ПеГАС 2014-2017». Клиническая микробиология и антимикробная химиотерапия. 2019;21(3):230-37.
  46. Bjerre L.M., Verheij T.J., Kochen M.M. Antibiotics for community acquired pneumonia in adult outpatients. Cochrane Database Syst Rev. 2009;(4):CD002109. doi: 10.1002/14651858.CD002109.pub3.
  47. Pakhale S., Mulpuru S., Verheij T.J., et al. Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst. Rev. 2014;(10):CD002109. doi: 10.1002/14651858.CD002109.pub4.
  48. Postma D.F., van Werkhoven C.H., van Elden L.J., et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015;372:1312-23. Doi: 10.1056/ NEJMoa1406330.
  49. Чучалин А.Г, Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых. Клинические рекомендации (проект). 2019.
  50. Sivaya O., Kozlov R., Sukhorukova M., et al. Longterm surveillance of antimicrobial resistance of H. influenzae in Russia: are there any changes in ten years? ECCMiD 2016, Amsterdam, 9-12 April, Poster # EV0302.
  51. Maimon N., Nopmaneejumruslers C., Marras T.K. Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis. Eur Respir J. 2008;31:1068-76. doi: 10.1183/09031936.00109007.
  52. Lonks J.R., Garau J., Gomez L., et al. Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae. Clin infect. Dis. 2002;35:556-64. doi: 10.1086/341978.
  53. Daneman N., McGeer A., Green K., et al. Macrolide resistance in bacteremic pneumococcal disease: implications for patient management. Clin infect Dis. 2006;43:432-38.
  54. Чучалин А.Г, Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых. Практические рекомендации по диагностике, лечению и профилактике (пособие для врачей). Клиническая микробиология и антимикробная химиотерапия. 2010;12:186-225.
  55. Woodhead M., Blasi F., Ewig S. and the ERS/ESCMiD Task Force. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol infect. 2011;17(Suppl. 6):1-59. doi: 10.1111/j.1469-0691.2011.03672.x.
  56. Niederman M.S. in the Clinic: Community-Acquired Pneumonia. Ann Intern Med. 2015;163:1-17. doi: 10.7326/AITC201510060.
  57. Athlin S, Lidman C., Lundqvist A., et al. Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017. Infect. Dis. (Land). 2018;50:247-72. doi: 10.1080/23744235.2017.1399316.
  58. Cilloniz C, Ewig S., Polverino E., et al. Community-acquired pneumonia in outpatients: aetiology and outcomes. Eur Respir J. 2012;40:931-38. doi: 10.1183/09031936.00168811.
  59. Fantin B, Aubert J.P, Unger P, et al. Clinical evaluation of the management of community-acquired pneumonia by general practitioners in France. Chest. 2001;120:185-92. doi: 10.1378/chest.120.1.185.
  60. Minogue M.F, Coley C.M., Fine M.J., et al. Patients hospitalized after initial outpatient treatment for community-acquired pneumonia. Ann Emerg Med. 1998;31:376-80. doi: 10.1016/s0196-0644(98)70350-6.
  61. Prina E, Ranzani O.T, Torres A. Community-acquired pneumonia. Lancet. 2015;386:1097-108. doi: 10.1016/S0140-6736(15)60733-4.
  62. Tansarli G.S., Mylonakisa E. Systematic review and meta-analysis of the efficacy of short-course antibiotic treatments for community-acquired pneumonia in adults. Antimicrob. Agents Chemother. 2018;62(9):e00635-18. Doi: 10.1128/ AAC.00635-18.
  63. L pez-Alcalde J., Rodriguez-Barrientos R., Redondo-S nchez J., et al. Short-course versus long-course therapy of the same antibiotic for community-acquired pneumonia in adolescent and adult outpatients. Cochrane Database Syst Rev. 2018;9:CD009070. doi: 10.1002/14651858.CD009070.pub2.
  64. Silverman M., Povitz M., Sontrop J.M., et al. Antibiotic prescribing for nonbacterial acute upper respiratory infections in elderly persons. Ann Intern Med. 2017;166:765-74. doi: 10.7326/M16-1131.
  65. McDonagh M.S., Peterson K., Winthrop K., et al. Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review. J Int Med Res. 2018;46:3337-57. doi: 10.1177/0300060518782519.
  66. Froes F., Pereira J.G., Povoa P. Outpatient management of community-acquired pneumonia. Curr Opin Pulm Med. 2019;25:249-56. Doi: 10.1097/ MCP.0000000000000558.
  67. U.S. Food and Drug Administration. FDA approves new antibiotic to treat community-acquired bacterial pneumonia. URL: www.fda.gov/news-events/ pressannouncements/fda-approves-new-antibiotic-treat-community-acquiredbacterial-pneumonia.
  68. Rodvold K.A. Introduction: lefamulin and pharmacokinetic/ pharmacodynamic rationale to support the dose selection of lefamulin. J Antimicrob Chemother. 2019;74(Suppl3):iii2-4. Doi: 10.1093/ jac/dkz084.
  69. File T.M., Goldberg L., Das A., et al. Efficacy and safety of intravenous-to-oral lefamulin, a pleuromutilin antibiotic, for the treatment of community-acquired bacterial pneumonia: the phase III Lefamulin Evaluation Against Pneumonia (LEAP 1) Trial. Clin Infect Dis. 2019;69:1856-67. doi: 10.1093/cid/ ciz090.
  70. Alexander E., Goldberg L., Das A.F., et al. Oral lefamulin vs moxi oxacin for early clinical response among adults with community-acquired bacterial pneumonia: the LEAP 2 randomized clinical trial. JAMA. [e-pub Sep. 27, 2019].
  71. Nabriva Therapeutics. Nabriva Therapeutics receives U.S. FDA approval of Xenleta™ (lefamulin) to treat community-acquired bacterial pneumonia (CABP). URL: https://investors.nabriva.com/news-releases/ news-release-details/nabriva-therapeutics-receives-us-fda-approval-xenleta.
  72. Malani P.N. Lefamulin - a new antibiotic for community-acquired pneumonia. JAMA. [e-pub Sep. 27, 2019].
  73. Teng F., Liu X., Guo S.B., et al. Community-acquired bacterial co-infection predicts severity and mortality in influenza-associated pneumonia admitted patients. J Infect Chemother. 2019;25:129-36. doi: 10.1016/j.jiac.2018.10.014.
  74. Cantan B., Luyt C.E., Martin-Loeches I. Influenza Infections and Emergent Viral Infections in Intensive Care Unit. Semin Respir Crit Care Med. 2019;40:488-97. doi: 10.1055/s-0039-1693497.
  75. Bonten M.J., Huijts S.M., Bolkenbaas M., et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372:1114-25. Doi: 10.1056/ NEJMoa1408544.
  76. Frenck R.W. Jr., Gurtman A., Rubino J., et al. Randomized, controlled trial of a 13-valent pneumococcal conjugate vaccine administered concomitantly with an influenza vaccine in healthy adults. Clin Vaccine Immunol. 2012;19:1296-303. doi: 10.1128/CVI.00176-12.
  77. Schwarz T.F., Flamaing J., Rumke H.C., et al. A randomized, double-blind trial to evaluate immunogenicity and safety of 13-valent pneumococcal conjugate vaccine given concomitantly with trivalent influenza vaccine in adults aged >65 years. Vaccine. 2011;29:5195-202. doi: 10.1016/j.vaccine.2011.05.031.
  78. Ofori-Anyinam O., Leroux-Roels G., Drame M., et al. Immunogenicity and safety of an inactivated quadrivalent influenza vaccine co-administered with a 23-valent pneumococcal polysaccharide vaccine versus separate administration, in adults >50years of age: Results from a phase III, randomized, noninferiority trial. Vaccine. 2017;35:6321-28. doi: 10.1016/j.vaccine.2017.09.012.
  79. Centers for Disease Control and Prevention (CDC). Recommendations of the Advisory Committee on Immunization Practices (ACIP). URL: https://www. cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf.
  80. Козлов Р.С., Авдеев С.Н., Брико Н.И. и др. Вакцинопрофилактика пневмококковых инфекций у взрослых. Резолюция совета экспертов (Москва, 16 декабря 2017 г). Клиническая микробиология и антимикробная химиотерапия. 2018;20:5-8.
  81. Matanock A., Lee G., Gierke R., et al. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices. Morb Mortal Wkly Rep. 2019;68:1069-75. doi: 10.15585/mmwr.mm6846a5.
  82. Hedlund J., Kalin M., Ortqvist A. Recurrence of pneumonia in middle-aged and elderly adults after hospital-treatedpneumonia:aetiologyandpredisposing conditions. Scand J Infect. Dis. 1997;29:387-92. doi: 10.3109/00365549709011836.
  83. Козлов Р.С., Сухорукова М.В., Сивая О.В. и др.Чувствительность к антимикробным препаратамклинических штаммов Streptococcus pneumoniae,выделенных в различных регионах РФ в 2010-2013гг. Клиническая микробиологияи анти-микробная химиотерапия. 2015;17(Приложение1):31.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2020 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies