Table 1.
Major Changes in Recommendations From 2007 to 2019 American Thoracic Society/Infectious Diseases Society of America Community-Acquired Pneumonia Guidelines
| Recommendation | 2007 ATS/IDSA Guideline | 2019 ATS/IDSA Guideline |
|---|---|---|
| Sputum culture | Primarily recommended in patients with severe disease | Now recommended in patients with severe disease as well as in all inpatients empirically treated for MRSA or Pseudomonas aeruginosa |
| Blood culture | Primarily recommended in patients with severe disease | Now recommended in patients with severe disease as well as in all inpatients empirically treated for MRSA or P aeruginosa |
| Macrolide monotherapy | Strong recommendation for outpatients | Conditional recommendation for outpatients, based on resistance levels |
| Use of procalcitonin | Not covered | Not recommended to determine need for initial antibacterial therapy |
| Use of corticosteroids | Not covered | Recommended not to use. May be considered in patients with refractory septic shock |
| Use of health-care-associated pneumonia category | Accepted as introduced in the 2005 ATS/IDSA hospital-acquired and ventilator-associated pneumonia guidelinesa | Recommend abandoning this categorization. Emphasis on local epidemiology and validated risk factors to determine need for MRSA or P aeruginosa coverage. Increased emphasis on deescalation of treatment if cultures are negative |
| Standard empiric therapy for severe CAP | β-Lactam/macrolide and β-lactam/fluoroquinolone combinations given equal weighting | Both accepted but stronger evidence in favor of β-lactam/macrolide combination |
| Routine use of follow-up chest imaging | Not addressed | Recommended not to obtain. Patients may be eligible for lung cancer screening, which should be performed as clinically indicated |
ATS = American Thoracic Society; CAP = community-acquired pneumonia; IDSA = Infectious Diseases Society of America; MRSA = methicillin-resistant Staphylococcus aureus.
a
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.31