Neumonia

SUPPLEMENT ARTICLE

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults
Lionel A. Mandell,1,a Richard G. Wunderink,2,a Antonio Anzueto,3,4 John G. Bartlett,7 G. Douglas Campbell,8 Nathan C. Dean,9,10 Scott F. Dowell,11 Thomas M. File, Jr.12,13 Daniel M. Musher,5,6 Michael S. Niederman,14,15 AntonioTorres,16 and Cynthia G. Whitney11
1 3

McMaster University Medical School, Hamilton, Ontario, Canada; 2Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Texas Health Science Center and 4South Texas Veterans Health Care System, San Antonio, and 5Michael E. DeBakey Veterans Affairs Medical Center and 6Baylor College of Medicine, Houston, Texas; 7Johns HopkinsUniversity School of Medicine, Baltimore, Maryland; 8 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; 9Division of Pulmonary and Critical Care Medicine, LDS Hospital, and 10University of Utah, Salt Lake City, Utah; 11Centers for Disease Control and Prevention, Atlanta, Georgia; 12Northeastern Ohio Universities College of Medicine,Rootstown, and 13Summa Health System, Akron, Ohio; 14State University of New York at Stony Brook, Stony Brook, and 15Department of Medicine, Winthrop University Hospital, Mineola, New York; and 16Cap de Servei de Pneumologia i Allergia Respiratoria, Institut Clınic del Torax, Hospital Clınic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut ` ` ´ ` ´ d’Investigacions BiomediquesAugust Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain. `

EXECUTIVE SUMMARY Improving the care of adult patients with communityacquired pneumonia (CAP) has been the focus of many different organizations, and several have developed guidelines for management of CAP. Two of the most widely referenced are those of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society(ATS). In response to confusion regarding differences between their respective guidelines, the IDSA and the ATS convened a joint committee to develop a unified CAP guideline document. The guidelines are intended primarily for use by emergency medicine physicians, hospitalists, and primary care practitioners; however, the extensive literature evaluation suggests that they are also an appro-priate starting point for consultation by specialists. Substantial overlap exists among the patients whom these guidelines address and those discussed in the recently published guidelines for health care–associated pneumonia (HCAP). Pneumonia in nonambulatory residents of nursing homes and other long-term care facilities epidemiologically mirrors hospital-acquired pneumonia and should be treatedaccording to the HCAP guidelines. However, certain other patients whose conditions are included in the designation of HCAP are better served by management in accordance with CAP guidelines with concern for specific pathogens.
Implementation of Guideline Recommendations

Reprints or correspondence: Dr. Lionel A. Mandell, Div. of Infectious Diseases, McMaster University/Henderson Hospital, 5th Fl., Wing40, Rm. 503, 711 Concession St., Hamilton, Ontario L8V 1C3, Canada (lmandell@mcmaster.ca). This official statement of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) was approved by the IDSA Board of Directors on 5 November 2006 and the ATS Board of Directors on 29 September 2006. a Committee cochairs. Clinical Infectious Diseases 2007; 44:S27–72 2007 bythe Infectious Diseases Society of America. All rights reserved. 1058-4838/2007/4405S2-0001$15.00 DOI: 10.1086/511159

1. Locally adapted guidelines should be implemented to improve process of care variables and relevant clinical outcomes. (Strong recommendation; level I evidence.)

It is important to realize that guidelines cannot always account for individual variation among patients. They...