Treatment of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies

被引：129

作者：

Ramirez, Julio A. ^{[1
]}

Musher, Daniel M. ^{[2
,3
]}

Evans, Scott E. ^{[4
]}

Dela Cruz, Charles ^{[5
]}

Crothers, Kristina A. ^{[6
]}

Hage, Chadi A. ^{[7
]}

Aliberti, Stefano ^{[8
,9
,10
]}

Anzueto, Antonio ^{[11
,12
]}

Arancibia, Francisco ^{[13
,14
]}

Arnold, Forest ^{[1
]}

Azoulay, Elie ^{[15
]}

Blasi, Francesco ^{[8
,9
,10
]}

Bordon, Jose ^{[16
]}

Burdette, Steven ^{[17
]}

Cao, Bin ^{[18
]}

Cavallazzi, Rodrigo ^{[19
]}

Chalmers, James ^{[20
]}

Charles, Patrick ^{[21
,22
]}

Chastre, Jean ^{[23
]}

Claessens, Yann-Erick ^{[24
]}

Dean, Nathan ^{[25
,26
]}

Duval, Xavier ^{[27
,28
]}

Fartoukh, Muriel ^{[29
]}

Feldman, Charles ^{[30
,31
]}

File, Thomas ^{[32
,33
]}

Froes, Filipe ^{[34
]}

Furmanek, Stephen ^{[1
]}

Gnoni, Martin ^{[1
]}

Lopardo, Gustavo ^{[35
]}

Luna, Carlos ^{[36
]}

Maruyama, Takaya ^{[37
]}

Menendez, Rosario ^{[38
]}

Metersky, Mark ^{[39
,40
]}

Mildvan, Donna ^{[41
]}

Mortensen, Eric ^{[42
]}

Niederman, Michael S. ^{[43
,44
]}

Pletz, Mathias ^{[45
]}

Rello, Jordi ^{[46
,47
]}

Restrepo, Marcos, I ^{[11
,12
]}

Shindo, Yuichiro ^{[48
]}

Torres, Antoni ^{[49
]}

Waterer, Grant ^{[50
]}

Webb, Brandon ^{[51
,52
]}

Welte, Tobias ^{[53
]}

Witzenrath, Martin ^{[54
,55
]}

Wunderink, Richard ^{[56
]}

机构：

[1] Univ Louisville, Div Infect Dis, 501 E Broadway,Ste 100, Louisville, KY 40292 USA

[2] Baylor Coll Med, Houston, TX 77030 USA

[3] Michael E DeBakey VA Med Ctr, Houston, TX 77030 USA

[4] Univ Texas MD Anderson Canc Ctr, Dept Pulm Med, Houston, TX 77030 USA

[5] Yale Univ, Pulm Crit Care & Sleep Med, New Haven, CT USA

[6] Univ Washington, Vet Puget Sound Hlth Care Syst, Seattle, WA 98195 USA

[7] Indiana Univ, Thorac Transplant Program, Indianapolis, IN 46204 USA

[8] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy

[9] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Resp Unit, Milan, Italy

[10] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Cyst Fibrosis Adult Ctr, Milan, Italy

[11] Audie L Murphy Mem Vet Adm Med Ctr, 7400 Merton Minter Blvd, San Antonio, TX 78284 USA

[12] Univ Texas Hlth, San Antonio, TX USA

[13] Inst Nacl Torax, Pneumol Serv, Santiago, Chile

[14] Clin Santa Maria, Santiago, Chile

[15] St Louis Teaching Hosp, Assistance Publ Hop Paris, Med ICU, Paris, France

[16] Providence Hlth Ctr, Sect Infect Dis, Washington, DC USA

[17] Wright State Univ, Boonshoft Sch Med, Dayton, OH 45435 USA

[18] China Japan Friendship Hosp, Ctr Resp Med, Natl Clin Res Ctr Resp Dis, Dept Pulm & Crit Care Med, Beijing, Peoples R China

[19] Univ Louisville, Div Pulm Crit Care & Sleep Disorders Med, Louisville, KY 40292 USA

[20] Ninewells Hosp & Med Sch, Scottish Ctr Resp Res, Sch Med, Dundee, Scotland

[21] Austin Hlth, Dept Infect Dis, Melbourne, Vic, Australia

[22] Univ Melbourne, Dept Med, Melbourne, Vic, Australia

[23] Sorbonne Univ, Hop La Pitie Salpetriere, AP HP, Serv Med Intens Reanimat, Paris, France

[24] Ctr Hosp Princesse Grace, Dept Emergency Med, Monaco, Monaco

[25] Intermt Med Ctr, Salt Lake City, UT USA

[26] Univ Utah, Salt Lake City, UT USA

[27] Hop Bichat Claude Bernard, AP HP, UMR 1137, IAME,INSERM, Paris, France

[28] Hop Bichat Claude Bernard, AP HP, CIC 1425, Paris, France

[29] Hop Tenon, AP HP, Serv Med Intens Reanimat, Paris, France

[30] Sorbonne Universit, Fac Med, AP HP, Paris, France

[31] Univ Witwatersrand, Fac Hlth Sci, Dept Internal Med, Johannesburg, South Africa

[32] Northeast Ohio Med Univ, Infect Dis Sect, Akron, OH USA

[33] Summa Hlth, Infect Dis Div, Akron, OH USA

[34] Ctr Hosp Univ Lisboa Norte, Chest Dept, ICU, Hosp Pulido Valente, Lisbon, Portugal

[35] Fdn Ctr Estudios Infectol, Buenos Aires, DF, Argentina

[36] Univ Buenos Aires, Pulm Dis Div, Buenos Aires, DF, Argentina

[37] Natl Hosp Org Mie Natl Hosp, Dept Resp Med, Tsu, Mie, Japan

[38] La Fe Univ & Polytech Hosp, Pneumol Dept, La Fe Hlth Res Inst, Valencia, Spain

[39] Univ Connecticut Hlth, Div Pulm Crit Care & Sleep Med, Farmington, CT USA

[40] Univ Connecticut Hlth, Ctr Bronchiectasis Care, Farmington, CT USA

[41] Icahn Sch Med Mt Sinai, New York, NY USA

[42] Univ Connecticut, Dept Med, Hlth Ctr, Farmington, CT 06032 USA

[43] New York Presbyterian Weill Cornell Med Ctr, Pulm & Crit Care, New York, NY USA

[44] Weill Cornell Med Coll, New York, NY USA

[45] Jena Univ Hosp, Inst Infect Dis & Infect Control, Jena, Germany

[46] Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Resp, Barcelona, Spain

[47] Vall dHebron Inst Res, Infect Area, Barcelona, Spain

[48] Nagoya Univ, Dept Resp Med, Grad Sch Med, Nagoya, Aichi, Japan

[49] Univ Barcelona, Hosp Clin, Serv Pneumol, CIBERES, Barcelona, Spain

[50] Univ Western Australia, Sch Med, Perth, WA, Australia

来源：

CHEST | 2020年 / 158卷 / 05期

关键词：

community-acquired pneumonia; immunocompromised; pneumonia; RESISTANT STAPHYLOCOCCUS-AUREUS; AMERICAN THORACIC SOCIETY; PNEUMOCYSTIS PNEUMONIA; BRONCHOALVEOLAR LAVAGE; DISEASES SOCIETY; RISK-FACTORS; DIAGNOSIS; INFECTION; GUIDELINES; PATHOGENS;

D O I：

10.1016/j.chest.2020.05.598

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. RESEARCH QUESTION: There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP. STUDY DESIGN AND METHODS: This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. RESULTS: The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens. INTERPRETATION: This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.

引用

页码：1896 / 1911

页数：16

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