International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

TLDR

Recent European guidelines on hospital‑acquired and ventilator‑associated pneumonia were published nearly a decade ago, but subsequent trials and studies on epidemiology, diagnosis, empiric treatment, new antibiotics, and prevention have altered prevailing paradigms and revealed differences between European and U.S. approaches. The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. The guideline panel comprised representatives from European societies (ERS, ESICM, ESCMID), the Latin American Thoracic Association, and 15 experts plus two methodologists, including three U.S.

Abstract

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent. The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited. A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink). Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population–intervention–comparison–outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.