2019 IDSA Guidelines for Community Acquired Pneumonia in Adults: To HCAP, we just say fare thee well

2019 IDSA Guidelines for Community Acquired Pneumonia in Adults: To HCAP, we just say fare thee well

by Jon-Emile S. Kenny 

New guidelines from the American Thoracic Society/Infectious Disease Society of America

Background 

The last American Thoracic Society/Infectious Disease Society of America [ATS/IDSA] guidelines on community acquired pneumonia [CAP] were published in 2007; it seems hard to remember the world at that time – free from the tweeting of medical information, free from the tweeting of world leaders.  Is 2019 better for everyone?  Worse?  For some?

The 2019 inception of the ATS/IDSA guidelines for CAP reserves a more pragmatic approach than its screed-like predecessor – clearly defining 16 high-yield clinical questions and answering them under the direction of the PICO framework.  Critically, the current recommendations make clear that:

“This guideline focuses on patients in the United States who have not recently completed foreign travel…. on adults who do not have an immunocompromising condition, such as inherited or acquired immune deficiency or drug-induced neutropenia, including patients actively receiving cancer chemotherapy, patients infected with HIV with suppressed CD4 counts, and solid organ or bone marrow transplant recipients.”

Accordingly, and as mentioned in the 2016 update on hospital-acquired and ventilator-associated pneumonia, guidelines remain guidelines.  They are not sacrosanct; they needn’t be followed without falter in all patients, always; clinical judgement and individual patient characteristics are also guiding principles.  In my humble opinion, the only deontological imperative is that you are informed and the current IDSA CAP guidelines are an excellent fund of rational, practical information.