ATS Releases New Community-Acquired Pneumonia Guidelines

The American Thoracic Society has released new clinical practice guidelines for the treatment of community-acquired pneumonia (CAP).

In order to develop the guidelines, the panel, which included 12 clinicians and researchers with experience in pneumonia, conducted a systematic review of available literature and developed a Population-Intervention-Comparison-Outcome question.

Among the recommendations:

• In outpatients with suspected CAP, routine nucleic acid-based testing of respiratory samples for viral pathogens other than influenza should not be conducted (conditional recommendation, very-low-quality evidence).
• In hospitalized patients with suspected CAP, nucleic acid-based testing of respiratory samples for viral pathogens other than influenza should only be conducted in patients with:
  • severe CAP
  • who are immunocompromised

When writing the guidelines, the panel anticipated that decreased antibiotic use would be a significant effect of viral testing. However, they found little evidence of this.

“In theory, identification of viruses without concomitant bacteria might prompt clinicians to withhold antibiotics for CAP. However, possibly because of time lags in obtaining results of the respiratory virus panel even with POC tests, no studies have found that these tests are associated with a significant decrease in the initiation of antibiotic therapy,” the group wrote.

—Michael Potts

Reference:

Evans SE, Jennerich AL, Azar MM, et al. Nucleic acid–based testing for noninfluenza viral pathogens in adults with suspected community-acquired pneumonia. Am J Respir Crit Care Med. 2021;203(9):1070–1087. doi: 10.1164/rccm.202102-0498ST