Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

Lee, Mi Suk; Oh, Jee Youn; Kang, Cheol-In; Kim, Eu Suk; Park, Sunghoon; Rhee, Chin Kook; Jung, Ji Ye; Jo, Kyung-Wook; Heo, Eun Young; Park, Dong-Ah; Suh, Gee Young; Kiem, Sungmin

The community-acquired pneumonia guideline developed by the ATS/IDSA in 2007 proposes the new definition of severe pneumonia that requires ICU admission modified from the earlier definition proposed by the ATS in 2001 [15, 123] (Table 8 ). This standard consists of main and minor standards. The main standard includes dependence on mechanical ventilation, and septic shock that requires vasopressors. The minor standard consists of seven conditions, which include the factors included in the 2001 ATS standard [123] , plus clinical factors from the CURB-65. A patient is diagnosed with severe pneumonia if he/she satisfies one of the conditions from the main standard, or three of the seven conditions from the minor standard. This standard is reported to have higher predictive power than the PSI ≥4 or CURB-65 ≥3 [124] . However, although the predictive power of the standard is improved relative to that of the PSI or CURB-65 when only the minor conditions are used (excluding patients who satisfy the main conditions for ICU admission), and the standard has good specificity, it has moderate sensitivity [125] . It has also been reported that since some of the factors included in the minor standard (leukopenia, thrombocytopenia, and hypothermia) are rarely observed in patients, the predictive power of the minor standard does not change even after these factors are excluded, and that adding other factors can increase its predictive power [126] . There are other scoring systems such as the SMART-COP [127] , and the SCAP [128] that are used to predict ICU admission, but they also have similar limitations.