Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults

Abstract

This document presents the evidence-based guidelines of the Swedish Society of Infectious Diseases for the management of adult immunocompetent patients with community-acquired pneumonia (CAP), who are assessed at hospital. The prognostic score 'CURB-65' is recommended for all CAP patients in the emergency room. The score provides an assessment tool for the decision regarding outpatient treatment or level of hospital supervision, the choice of microbiological investigations, and empirical antibiotic treatment. In patients with non-severe CAP (CURB-65 score 0-2) we recommend initial narrow-spectrum antibiotic treatment, orally or intravenously, primarily directed at Streptococcus pneumoniae. In those with CURB-65 score 3, penicillin G or a cephalosporin intravenously is recommended. For CURB-65 score 0-3 atypical pathogens should be covered only when they are suspected on clinical or epidemiological grounds. In patients with CURB-65 score 4-5 intravenous combination therapy with either cephalosporin/macrolide or penicillin G/fluoroquinolone is recommended. Efforts should be made to identify the CAP aetiology in order to support the ongoing antibiotic treatment or to suggest treatment alterations. Recommended measures for prevention of CAP include influenza -- and pneumococcal -- vaccination to risk groups and efforts for smoking cessation.

Contribution of host, bacterial factors and antibiotic treatment to mortality in adult patients with bacteraemic pneumococcal pneumonia

“…To obtain complete data on mortality, the database was linked to Statistics Sweden using the unique personal identification number given to all Swedish citizens 19. The Swedish national guidelines on the clinical management of CAP published in 2005 recommend that all patients with suspected pneumonia assessed at a hospital should have a chest x-ray and two blood cultures performed 20. Treatment regimens should be based on the severity of pneumonia graded according to CURB-65 where patients with non-severe CAP (0–2 points) are recommended treatment with penicillin G, patients with 3 points are recommended treatment with penicillin G or a cephalosporin and patients with very severe CAP (4–5 points) are recommended treatment with a cephalosporin in combination with a macrolide or penicillin G in combination with moxifloxacin/levofloxacin.…”

Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage

“…As sputum cultures may be contaminated by the oropharyngeal flora, so fibreoptic bronchoscopic techniques have been developed to enable collection of lower respiratory tract samples with minimal risk of contamination. At present, a major reason for fibreoptic bronchoscopy (FOB) in LRTI patients is failure to respond as expected to the first-line antibiotic treatment [2,3]. However, PRATS et al [4] demonstrated that the culture yield of Streptococcus pneumoniae and Haemophilus influenzae is rapidly reduced in lower respiratory tract secretions during antibiotic treatment; because of this, PRATS et al [4] and other groups [5,6] have suggested that FOB should be performed earlier in the course of LRTI, if possible prior to antibiotic treatment.…”

Application of vibration response imaging technology in patients with community-acquired pneumonia before and after the treatment

“…According to the statistics, there were ~6.5–15 million persons suffering from CAP each year, among which over 200,000 persons died of CAP. All guidelines on CAP mentioned that imaging examination was the main examination means of CAP diagnosis and evaluation of therapeutic effects (10–12). At present, there are a few reports on the studies on the application of VRI technology in CAP patients.…”